FEBRILE SEIZURES

BY: SHETTY DIVYA KARUNAKAR

4th year MBBS, KODAGU INSTITUTE OF
MEDICAL SCIENCE.
 PARTICULARS

NAME: Miss ABC PARENT NAME: Mrs.XYZ.

AGE: 2yrs. AGE: 28 yrs
SEX: Female. EDUCATION :B. com
BIRTH ORDER: 1st OCCUPATION :Housewife.
SES: Upper middle class. Reliable
ADDRESS: Napolkalu, Kodagu.
DOA:7th August 2020

DOE:7th August 2020

CHIEF COMPLAINTS :
• Fever 2 days ago
• Convulsions 2days ago
 HISTORY OF PRESENTING ILLNESS
• The patient was apparently alright 3 days back. Then she
developed fever 3 days ago. It was acute in onset, progressive
in nature. Lasts throughout the day and aggravates during the
evening. No relieving factors. It was associated with night
sweats and chills.
irritability and increasing crying in the morning hours.
Associated with sleep disturbance and decreased feeding. Not
associated with vomiting.
• Also presented with a paroxysmal event of electric shock like
contractions of the body on the second day of fever. It lasted
for about 3 minutes and no loss of consciousness following the
event . It was associated with vomiting prior to the event . After
the event, the patient experienced some dizziness and fatigue.
She remembers the episode of the attack. No complaints of
associated speech disturbances, walking difficulties or
decreased vision after the attack.
• No associated ear discharge or ear pain. No difficulty
breathing, joint pains, chest pain.
• No involuntary movements.
• No abdominal pain.
• No rashes.
 PAST HISTORY
• No prior exposure to any infectious disease.
• No history of surgical or medical intervention.
 FAMILY HISTORY
• Father gives history of a similar episode during his childhood.
It was a single episode following a fever without any relapses
or residual effects.
• Pedigree chart
• No family h/o
• Infectious diseases
• TB, DM
• Hypertension
 PERSONAL HISTORY

• No history of allergies.
• Bowel and bladder movements normal.
• Appetite decreased since a week.
• Sleep disturbed.
 ANTENATAL HISTORY
• 1st trimester :
• Birth order :1.
• Pregnancy was confirmed after 4 weeks of amenorrhoea by
UPT.
• Vomiting +. Fatigue +
• Folic acid and calcium supplements taken.
• No h/o fever, exposure to radiation, burning micturition,
leaking PV or bleeding PV.
No increased frequency of micturition.
Regular ANC visits.
• USG – At 4 weeks.
2nd Trimester :
• Quickening felt at 5th month of gestation.
• Vomiting +.
• Increased frequency of micturition.
• USG- 10 weeks.
• Iron and Folic acid tablets taken.
• No h/o headache fever, giddiness, swelling in lower limb, blurring of
vision.
No leaking PV or bleeding PV.
• No abdominal pain.
3rd trimester :
• Fetal movements perceived and increased in frequency.
• No vomiting, giddiness.
• Increased frequency of micturition +.
• No h/o headache, fever, giddiness, edema in lower limbs, blurring of
vision.
• No leaking or bleeding PV.
• Iron and Folic acid supplements taken.
• USG – 32 weeks.
 NATAL HISTORY :
• LMP :31/12/2017
• EDD:7/9/2018.
• Birth order:1st.
• Delivered on 14/9/2018 at District Hospital.
• Normal vaginal delivery.
 POST NATAL HISTORY :
• She delivered a healthy baby girl, Ria Prabhu, weighing 2.6kg
at birth.
• Cried immediately after birth.. Breast fed within 1hr of
delivery.
• No resuscitation measures were taken.
• BCG, tetanus, HepB vaccination were administered.
 PAST OBSTETRICS HISTORY OF
MOTHER:
• Married for 4yrs.
• Non consanguineous marriage.
• No h/o abortions.
 NUTRITIONAL HISTORY OF CHILD.
CONTENT QUANTITY CALORIES (kcal)
HUMAN MILK 1L 700
RICE 100g×2 350×2
DAL 100g×2 300×2
POTATO 100g 100
APPLE 1 40
BISCUITS 2 100
BANANA 1 60
 DEVELOPMENTAL HISTORY
Gross motor milestones :
• 3months – neck holding
• 5 months – rolling over
• 6 months—sits with support, tripod sitting.
• 8 months-sits without support, crawls.
• 10 months—stands with support, creeping
• 11months- cruising.
• 12months – Stands without support, walks with support.
• 15 months-walks without support.
• 18 months-runs.
• 2 years – climbs up the stairs 2 foot per step.
FINE MOTOR MILESTONES
• 2months – palmar grasp
• 4 months – bidextrous grasp.
• 6 months- unidextrous grasp
• 8 months – mature palmar grasp
• 9 months – immature pincer grasp.
• 12 months-mature pincer grasp
• 15 months—able to scribble
• 18 months- able to draw a horizontal line
• 2 yrs – able to draw a vertical line.
LANGUAGE MILESTONES :
• 3 months- cooing
• 6 months – monosyllable
• 9 months- bisyllable
• 1yr-1 to 2 words
• 15 months- Jargon speech
• 18 months- 8 to 10 words
• 2 yrs- 2 words sentences
SOCIAL MILESTONES :
• 2 months- social smile
• 3months – mother regard
• 6 months- stranger anxiety
• 9 months- waves bye bye
• 10 months- plays peek a boo
• 12 months – plays simple ball game
• 15 months- points at objects
• 18 months – domestic mimicry
• 2 yrs- parallel play
 IMMUNIZATION HISTORY
• At birth : BCG, bOPV-1, HBV-1.
• 6 weeks: IPV-1,HBV-2,DTP1,Rota-1,PCV-1.
• 10 weeks: IPV-2,DTP-2 Hib-2,Rota-2,PCV-2.
• 14 weeks: IPV-3,DTP-3, Hib-3,Rota-3 PCV-3.
• 6months:bOPV-2,MMR-1.
• 12 months: IPV-1, Hib-B1, PCV-1
• 15months: DTP-B1 MMR-2.
 SOCIOECONOMIC STATUS:
• Father is a school teacher in their town. Studied till B. Ed. Income of Rs.
15000 per month.
• Mother is a homemaker
• Belongs to upper class according to modified BG Prasad classification.
• No h/o firewood use/smoking in family members.
• Good ventilation, no over crowding.
• Toilet in the house.
• Continuous water supply from tap.
 SUMMARY
• Here is a two year old baby girl who is born out of a non
consanguineous marriage. Presented with the chief complaints
of fever since 3 days and seizures 2 days back. There is no past
history of such episodes. There is a family history of similar
episode of childhood seizure following a fever. The child has
normal nourishment and is immunized till date. Normal
milestones.
• Based on history, it maybe a case of febrile seizures.
 GENERAL PHYSICAL
EXAMINATION
• Child is conscious playful and alert.
• Vitals : pulse rate 86 beats/minute normal volume and normal
rhythm
• Respiration 24 times /minute Abdominothoracic respiration
• Blood pressure 86/42mmHg taken in left brachial artery
• Temperature Febrile. 100.2°F
• Pallor – Not present
• Icterus- Not present
• Cyanosis – Not present
• Clubbing – Not present
• Koilonychia- Not present
• Edema – Not present
• Lymphadenopathy - Not present
 ANTRHOPOMETRY
PARAMETERS OBSERVED
Height 88cm
Weight 12kg
BMI 15.49
Chest circumference 42cm
Head circumference 47cm
US/LS 1.7
Mid arm circumference 15cm
 HEAD TO TOE EXAMINATION
• Skull shape: normal, anterior fontanelle closed, it is not
bulging, no pulsations visible. Posterior fontanelle closed.
• Hair: black, no colour changes.
• Eyes:no Pallor, Icterus, KF rings, bitot’s spots, dryness, not
sunken.
• Ears:no discharge seen.
• Nose: no flaring of ala nasi, no septal deviation.
• Lips: no cleft lip, no Cyanosis.
Mouth : no cheilosis, stomatitis, bleeding gums
Tongue:no Pallor, Cyanosis, oral thrush
Neck: normal, no use of scalene muscles for respiration.
• Nails: no Clubbing.
• Skin:no skin lesions, BCG Scar present on left arm.
• Abdomen and genitalia: normal
• Spine and back:normal
• Lower limb:normal.
• No peripheral Cyanosis.
• No edema and Lymphadenopathy.
• No dysmorphic features.
 SYSTEMIC EXAMINATION

Nervous system examination

• Higher mental function –
• CooperativeConscious
• Intelligence normal
Speech normal
• Cranial nerves examination
• Olfactory nerve Normal
• Optic nerve
• Light reflex direct and indirect present
• Accommodation reflex prsent
• Cranial nerves 3, 4, 6
• Movement in all direction normal
• Pupil position Central
• size 2 mm diameter
• shape circular
• Symmetrical.
• No ptosis.
• 5th cranial nerve.
• Sensory - sensation over the face+
• Reflex- corneal reflex , jaw jerk present
• 7th cranial nerve
• Forehead frowning present
• Eyebrow raising present
• Eye closure NormaL
• Teeth showing normal
• Blowing the cheek normal
• Naso labial fold present
• Weak platysma
• Taste sensation over anterior two third of tongue present
• 9th and 10th cranial nerve
• Movement of palate normal
• Position of uvula – central.
• Taste sensation over posterior one third of tongue present
11th cranial nerve
• Shrugging of shoulders present
• Turning neck against resistance present
• 12th cranial nerve
Protrusion of tongue norma
Fasciculation abs
Wasting absentent
No deviation no dysarthria
• Motor system
Attitude of the Limbs
Upper Limbs normal
Lower Limbs normal
• Nutrition
• Upper Limbs – arm :15cm normal
• forearm :10cm normal.
• Tone :Upper Limbs—normal
• Lower Limbs normal
• Power:
• Grade 5 in upper Limbs and lower limbs.
• Shoulder: adduction, Abduction, flexion, extension normal
• Elbow :flexion extension normal
• Wrist :Flexion extension normal
• Hip adduction and abduction flexion extension normal
• Knee Flexion extension normal
• Ankle dorsiflexion plantar flexion normal
• Coordination :
• Upper Limb finger nose test normal
• Drawing circle normal
• Lower limb: knee heel test normal
• No gait abnormalities.
Reflexes:
• Superficial reflexes-
• Corneal reflex Normal
• Abdominal reflex normal
• Plantar reflex normal
• Babinski sign normal (+)
• deep tendon reflexes-
• Biceps +
• Triceps+
• Supinator reflex +
• Knee jerk+
• Ankle jerk+
• Sensory system
• 1. Superficial :
• Touch +
• Temperature+
• Pain+
• 2. Deep:
• Pressure+
• Crude touch+
• Vibration+
• Joint sensation +
• Position sensation+
• 3.cortical sensation:
• Tactile localisation+
• Tactile discrimination+
• Cerebellar system examination :
• Nystagmus –
• Scanning of speech-
• Intentional tremors –
• Rebound phenomenon –
• Knee heel test normal
• Meningeal signs:
• Neck stiffness –
• kernig’s sign-
• brudzinski’s sign-
 SYSTEMIC EXAMINATION
• Respiratory system :
• Upper respiratory tract
• Nose :flaring of ala nasi seen..
• Oropharynx:Appears to be normal no tonsillar enlargement
• Posterior pharyngeal :wall normal
• Lower respiratory tract examination:
• Inspection
• Chest elliptical in shape
• Symmetrical movement on both sides with respiration
• Subcostal and intercostal retractions present with use of accessory
musclesTrachea is central in position
• Apical beat not seen
• No scars sinuses dilated veins
• No dropping of shoulder rib crowding
 PALPATION
• No tenderness
• No local rise of temperature
• Position of trachea Central
• Apical impulse felt at 4th intercostal space in MCL
• Chest expansion equal on both sides
• Vocal fremitus normal
Percussion
• Resonant tone elicited on bilateral lung fields
• Auscultation
• Nornormal.sicular sound present on all lung regions.
• Vocal resonance normal.
• CVS : S1, S2 heard. No murmurs.
• Abdominal examination :no tenderness, no guarding, no
ascites.
 PROVISIONAL DIAGNOSIS
• It is a case of febrile seizures, most probably of genetic
etiology.
Thank you