MINITASK 3

You are the doctor on duty. In quick succession 3 patients are brouhgt to you by the emergency
services

Determine the diagnosis in all the patients, and suggest the management and treatment (ambulatory x
hospitalization, standard x intensive care unit, paraclinical examinations including their timing).


A)    A 15-month-old boy without perinatal risk factors, 3 days lasting viral subfebrile/febrile
upper respiratory tract infection

During the uprise of the temperature to almost 39°C, a fit of convulsion of the whole body
accompanied by loss of contact and tonic upgaze occurs, with spontaneous termination in less than 2
minutes

On the examination the boy is fully conscious, without meningeal irritation, after the
administration of antipyretics the temperature has dropped


B)    A 11-month-old boy with the history of perinatal asfyxia, but so far normal psycho-motor
development, 2-3 days teething period, subfebrile

Today at home sudden eye deviation to the left, followed by progressive loss of contact and rhytmic
jerks of the left-sided extremities, lasting untill the i.v. administration of Apaurin 5mg – in
total about 25 minutes


C)    8-year-old girl, without the history of perinatal complications, with normal psychomotor
development

Currently 2-3 days lasting fever (without response to antipyretics) with intermittent headache and
vomiting

Today during the febrile period the fit of convulsions of the whole body with impaired
consciousness and loss of sphincter control, spontaneous termination in less than 2 mins

During the examination the girl is fully conscious, tired, photosensitive, with a painful reaction
to the head anteflexion

Shortly after the initial exam, the seizure recurs