Slide Lapkas
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Case Report : Complex Febrile
Seizure due to Acute Rhinopharyngitis
Presented by: Diska AstariniSupervisor: dr. Sumardi Fransiskus, M.biomed, Sp.A
2
Patient Identity
• Name : DPP
• Sex : Male
• Age : 1 year 5 month
• Religion : Catholic
• Address : Rantau village,Monterado
• Date of birth : 3 October 2013
• Date of : 17 March 2015
hospitalization
History Taking
4
Main Complaint
a 1 year old boy was brought to the
emergency room of Abdul Aziz
Hospital on March, 17th , 2015 due
to seizure 4 hours before the
hospitalization
•1 week before
• Cough• Rhinorhea
•1 days before
• Fever• No
temperature was documented
• Temporarily relieved by Paracetamol syrup
•7 hours before
• 1st seizure• Lasted for <5
minutes• Eyes rolling
upward + rhytmic jerking of the upper and lower extremities
• crying after the seizure and then sleep
•4 hours before
• 2nd seizure• < 10
minutes• 4 limbs
jerky movement
• Regain consciousness and crying after the seizure
6
Systemic review
▫Pasient didn’t complain about
dyspnea, chill, bruised, epistaxis,
gums bleeding or joint swelling.
▫Defecation and urinate pattern was
the same as usual
Body Systems Complaints
General No weight loss, no loss of appetite
Cardiovascular No Leg Swelling, No Chest Pain, no palpitation, no shortness ofbreath
Respiratory No shortness of breath, no noisy breathing, cough, rhinorhea, no hemoptisis
Gastrointestinal No diarrhea, no hematemesis, no constipation
Genitourinary No increase in freqency of micturation, no dysuria, no incontinence, no flank pain no hematuria
CNS No LOC after attack, no headache , no history of trauma
7
Past Medical History
• Never had history of the seizure with or
without fever before.
• Never had been hospitalized or
undergone any surgery before.
• Had no long term illnesses
• Never had history of alergy, asthma
Family’s medical history
• Patient’s father had history of febrile
seizure during his childhood lives
• No epilepsy history in the family
9
History of mother’s pregnancy
• Never consumed “jamu” or other
drugs without doctor prescription
• Never had fever , hypertension or
fluor albus
• ANC every month at midwife’s clinic
Birth history
• He was born full term by spontaneous
vertex presentation, delivery at home
supported by midwife, crying
immediately. The birth weight was 2800
gr. The delivery was uncomplicated and
there was no resuscitation required
11
Feeding history
• 0-4 month: breast milk only
• 4-10 month: breast milk + formula milk +
porridge
• 10 month : started to eat rice same with
other’s family menu.
12
Immunization History
Patient’s mother said that the basic
immunizations were complete . The
last immunization he took when his
age was 9 month
Developmental History
• All the developmental parameters were
normal according to statement of
patient’s mother. Patient look normal and
the developmental progress was the same
as other child around.
Social & Environmental History
• Patient is the only child. He lives with
his parents and his grandmother. None
of them was having fever or cough
before the patient even got one.
Genogram
70 yr 61 yr
35 yr 30 yr 23 yr
45 yr 42 yr
19 yr 15 yr 12 yr 7 yr
1 year 5 month
: patient
: another family with febrile seizure history
Physical Examination
17
General appearance:Concious and alert
Look hurts a little more
Well nourished
Vital Sign• BP : 80/60 mmHg
• RR : 104 bpm
• HR : 38 bpm
• T : 38,1o C
18
Antropometri• Height : 79 cm• Weight : 9 kg
• W/A : normal• H/A : normal• W/H : normal
Systemic Examination
• Cardiovascular : NAD
• Abdominal : NAD
• CNS : NAD
• Urogenital : NAD
• Respiratory:
Nose : Discharge (+)
pharynx : Reddish (+)
Lung : Wheezing (-/-), Crackles (-/-)
NEUROLOGY EXAMINATION
• Cranial nerve : there was no
nystagmus. All cranial nerve were
intact
• Muscle tone: No hypotonia and
hypertonia
• Signs of meningeal irritation: no
neck stiffness, negative brudzinski‘s
and kernig’s sign
21
Laboratory Finding
Parameter Standard 17/03/15
WBC
RBC
HGB
MCV
MCH
RDW
HCT
PLT
WIDAL
3.6-11.0 gr/l
4.20-6.20 x 106/l
11.7-17.3 g/dl
80-100 fl
26-34 pg
10,5-14,5 fl
38.0-54-0 %
150-440 x 103/l
Negatif
6,9 x 103 gr/l
4,80x 106/l
11,5 g/dl
67,0 fl
24,1 pg
11,1 % fl
32,2 %
428 x 103/l
O (Negatif)
H(Negatif)
22
Diagnosis
•Complex Febrile Seizure due to
Acute Rhinopharyngitis
Planning
• Electrolyte serum
• Glucose
• Lumbal Puncture (recommended)
24
Treatment
• ABC
• Bed rest
• Diet
• Drink warm fluids
• Avoid smoky environment
• Education to parents
• IVFD D5 ¼ NS 20 dpm mikro
+ oral intake fluid 73cc/day
• Inj. Diazepam IV 3 mg (if
seizure only)
• Inj. Metamizole 3x 90 mg
(T>38,5 ◦C)
• Diazepam per rectal 4,5 mg/
8 hours (T>38,5 ◦C)
• Paracetamol syrup 3x ¾
cthcc
• Ambroxol syrup 2x ½ cth
25
Prognosis
•Quo ad Vitam : Bonam
•Quo ad Functionam : Bonam
•Quo ad Sanactionam : Dubia
Ad Bonam
26
Case Analysis
27Anamnesis
Theory
“Seizure occuring in association with fever in children between 6 month and 60 month of age, absence of intracranial infection, metabolic disturbance or other metabolic disorder.”
(Pedoman Pelayanan Medis IDAI,2009)
Patient• 1 year 5 month old boy • More than 1 seizure attack
within 24 hours• Duration 5-10 minutes• Cough, rhinorrea, fever • No neurological deficit after
seizure• No evidence of intracranial
pathology or any metabolic derangement
Patient
• More than 1 seizure attack within 24 hours
• Duration 5-10 minutes • No neurological deficit
after seizure
• No evidence of intracranial pathology or any metabolic derangement
Theory“Classification of Febrile Seizures:
Simple (all of the following)• Duration of less than 15 minutes• Generalized • No previous neurologic
problems • Occur once in 24 hours
Complex (any of the following)
• Duration of more than 15 minutes
• Focal• Recurs within 24 hours.”
(Graves,2012)
Physical Examination
•Patients
• T: 38,1oC
• Nose: discharge (+)
• mouth: Pharynx : Reddish• Neurology examination:
Normal• Meningeal’s sign (-)
•Theory
• Temperature: fever
• Mental state: normal
• Cranial nerves are intact
• Neurology examination:
normal
• Meningeal’s sign: (-)
• Extracranium Infection
30
Laboratory Finding
PatientNormal level of :
• WBC
• Platelet
• Hemoglobin
• RBC
• Malaria: Negative
• Widal : Negative
Theory
• Laboratory studies are not routinely recommended unless clinically indicated.
• Any labs performed to identifying a source of fever
• LP : 12-18 Month are recommended
• EEG : not routinely recommended
(Seinfeld,2014)
31
Diagnosis PatientHistory taking: • 1 year 5 month old boy got
more than 1 seizure attack within 24 hours associated with fever, >15 minutes, no neurological deficit after seizure and there’s no evidence of intracranial pathology. History of febrile seizure in family.
Physical examination: • No neurological abnormality, no
neck stiffness, upper respiratory tract infection
Laboratory Finding• No abnormality detected
Theory• A seizure occuring in the
absence of CNS infection nor
caused by metabolic imbalance
with an elevated temperature in
a child between 6 months and 5
years
• Family history of seizure
• no neurological abnormality
before and after the seizure
• Frequency <4 times a year• (Pedoman Pelayanan Medis IDAI,2009)
32
Treatment
•Patient• IVFD D5 ¼ NS 20 dpm mikro +
oral intake fluid 73cc/day
• Inj. Diazepam IV 3 mg (if
seizure only)
• Inj. Metamizole 3x 100 mg
(T>38,5 ◦C)
• Diazepam per rectal 4,5 mg/ 8
hours (T>38,5 ◦C)
• Paracetamol drop 3 x ¾ cth
• Ambroxol drop 3x ½ cth
Theory• Maintain ABC
• Anticonvulsant control
seizure
• Antipiretic Control fever
33
Prognosis
Patient
• Quo ad vitam : Bonam
• Quo ad Functionam: Bonam
• Quo ad Sanactionam : Ad
Bonam
Theory• Generally, patients with febrile
seizure have a good
prognosis.
• mortality from febrile seizures
is very rare
• febrile seizures reoccur
frequently
34
Thank you