Neurology

A General Approach to Febrile Seizures

4 year old boy, otherwise healthy, is rushed into the emergency room by his mom because she thinks he had a seizure. His mom states he was sitting on the ground playing a game on his iPad when he suddenly started having jerking movements of his entire body that eventually self resolved after around 2 minutes. He has never had a seizure before. He is up to date on vaccines and had an unremarkable birth history. 

 

On exam, the child is not actively seizing at this time, he just seems slightly drowsy and confused. It is noted that he is febrile to 38.2 C, otherwise vitals are stable. The rest of the exam is nonfocal 

 

What should you be thinking about? What are your next steps?  

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Critical Cases - Hypertensive Encephalopathy!

You receive a prehospital stroke alert from ALS for a 73 yo male found down, minimally responsive. "Pretty routine" you think as you listen to report from the paramedic...that is, until you hear the vital signs: "Blood pressure is 270 over 140." That's the highest blood pressure you've ever heard of and you immediately begin to worry about how the human brain can possibly tolerate this as you head to the resuscitation bay to assemble your team...

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Critical Cases - Post LP Subdural Hematoma!

A 24 year old female presents to the ED complaining of a worsening headache after a lumbar puncture performed in the ED 2 days prior which diagnosed idiopathic intracranial hypertension. "No problem!" you think. Either this is just a post LP headache or possibly the patient needs more CSF drained to improve her headache. LP is a very safe procedure with minimal risk after all! Right?

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