A 3 month old male child presented to us with multiple episodes of seizures. There was a history of fever along with cough n cold. Patient had a history of obstructed labour n one day NICU stay. Reports are attached. Please provide ur precious views. I have added a photo of patient there some Neurocutaneous marker near left hypochondrium region.

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Family history of febrile seizure is very important .What about the developmental history.3 months old baby ,with out any neurological abnormality ( not mentioned any thing in the available notes),1st diagnosis is Febrile seizure.No mention about the neurological or systemic abnormality including skin lesions.So one can assume ,the child is normal. A normal child is getting seizure at 3 months with fever 1st diagnosis is Febrile fit but in view of the multiple episodes one has to exclude other causes also. The cause of fever needs blood work up. If any neck stiffness or irritability needs CSF study. Also needs EEg inview of recurrent episodes. NCCT posted is normal.

Thank you Ma'am for detailed explanation
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Dear dr Nitesh Prasad Reports are reflecting hyponatremia and hypocalcimia Ncct is showing ?hydrocephalus /mild cerebral atrophy suggest baby was hypoxic in NIU Encephalitis?

Sir i have corrected hyponatremia . Baby seizure episodes are being under control. Nicu history is erratic .parents are giving a reliable information . Planning to do a lumbar puncture.
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H/o recurrent seizure in last 3 Mon of age ?? In infant child with fever and seizure CSF examination is must.its not febrile seizure. Development history of child?? Anthropometry ?? Post CSF report and pic of child.

Its definitely not a febrile seizure anyhow. Parents didn't give consent for lumbar puncture though. Hard to convince them. How do u explain hyponatremia n cerebral atropy. I was waiting for u to answer.
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Hyponatrimia is responsible for convulsions correct sodium calcium alkalosis admit in nicu

I agree
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Do the seizures occur only during fever or otherwise also child has had multiple episodes? Are there infantile spasms, they occur like very subtle jerks, more on waking up from sleep in morning.. EEG can confirm the same.. if it is a 3 month old child also check for milestones such as is head holding present and is child playful and alert otherwise, moving all 4 limbs properly ...presence of head lag, poor tracking to light, paucity of movement, asymmetry are signs that there is more to it that just seizures ..

Child maintain eye contact with mother. Theres history seizure episodes in the past . Now they are associated with fever . How cerebral atropy affects developmental milestones
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In case of first febrile seizure usually no medication is started, but close watch is kept, if child has second episode of seizure then necessary to start medication, more so if child is also showing some developmental delay as it will add to neuro deficit... I am a Physiotherapist and do not have advanced knowledge of medicine prescription hence requesting other senior neurologists to advise.. Even if no medication is prescribed, parent is to be taught how to administer Midazolam spray and to always keep with them and administer as per instructions given in the box... Every seizure episode affects the Brain functioning and cognition in child.. hence care to be taken to prevent as much as we can .

No dr doctor its not febrile seizure . Febrile seizure occurs between 6 month n 5 years of age . In those cases midazolam intranasal spray is a good choice to abort the seizure .but theres a neurocutaneous marker .i will post the pic of the child.
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Febrile covulsion

Thank you doctor
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Check for underlying infection, tooth decay etc to find cause of both. Fever and resulting seizure

Tooth decay is rare in this age group doctor .since the child is on exclusive breast feeding . Though in older children dental caries should b considered as a source of infection .good point.
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Carbo veg

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