Shanika Uduwna PGY 2
1.Age of onset 2.Semiology 3.EEG 4.outcome
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A 5-month-old girl presents with a 1-week history of exaggerated startle movements and decreased motor and social activity. According to her parents, the child bends her head and trunk forward, extends her arms out quickly, and cries (Item Q166). Such actions may occur 10 to 20 times consecutively and have become more frequent over the past several days. She also is much less physically active and less interactive with her parents.(Item Q166)
A 6-year-old boy presents for evaluation due to an episode of screaming and confusion at night. The boy's parents heard him scream in his room, and when they went to him, he exhibited rapid twitching of his left arm and hand, stiffening of his left leg, rolled back eyes, and some blinking of both eyes. He was incoherent and minimally responsive for 5 to 10 minutes. After the episode, he was weak on the left side of his body. By morning, he had returned to a normal status. Of the following, the MOST likely diagnosis is
A 25-month-old girl who has neurodevelopmental delay is brought to the emergency department via ambulance. She had appeared well the entire day, with no signs of illness, but at approximately 8 pm, her mother saw the child start to bend over and then become unconscious, her left arm began jerking, and her eyes rolled back. Her father quickly picked up the limp child, who had some continued jerking of her left arm. The jerking did not involve her legs or face. Her eyes were deviated to the left, her breathing was irregular, and she had some blueness around her lips. The twitching lasted less than 1 minute. After about 15 minutes, she began to have some visual responsiveness, but it was several hours before she started to act normally. On physical examination in the emergency department, she has a temperature of 39.5°C and a right otitis media. Within 4 hours of administration of an antipyretic, she is afebrile and has returned to baseline status. The father states his brother had "fever seizures" in childhood. Of the following, the factor that increases this child's risk of later epilepsy is
A 4-year-old boy has had two fairly similar, brief episodes within the past month consisting of abrupt arrest of ongoing behavior, glassy- eyed staring, and lip smacking, followed by confusion and sleepiness for 1 hour. He has had no fevers or other signs of illness at the time of either event. Findings on his medical and developmental histories are otherwise normal. Physical and neurologic examination results are normal. Brain magnetic resonance imaging yields normal results, and electroencephalography shows no abnormalities. Of the following, the MOST appropriate treatment for this boy is
The mother of a 7-year-old boy brings in her son because he has been staring off into space in his second-grade classroom. The teacher is concerned that he may be having seizures. Of the following, the feature of staring spells that is MOST consistent with absence epilepsy is
A 17-year-old girl presents for evaluation after a first generalized tonic-clonic seizure, which occurred the morning after she was up late at a party. You suspect juvenile myoclonic epilepsy, a form of epilepsy that may present with seizures in adolescence. Of the following, the feature, if present, that is MOST consistent with this diagnosis is