Age: 1.0
Sex: M
Vaccine: HEPA, MMR, PNC13
Symptoms: Intensive care, Lumbar puncture normal, Muscle twitching, Myoclonus, Nuclear magnetic resonance imaging brain normal
Clinical narrative: From hospital report-"12 month-old previously healthy fully immunized male presents with seizures. Patient is a twin male born at 36w6d without any complications and did not require a NICU stay. Was developing normally and has not had any recent illness, fevers or trauma. He was in the care of his nanny that has been present for approximately 3-4 weeks he began having right arm twitching which turned into a generalized seizure and he fell down and nanny caught him. He continued to have a seizure for approximately 15 minutes while he was transported to the emergency department he did receive 1.3 mg of IM VERSED. In the emergency department he had a second seizure and received 1.7 mg of VERSED and he was intubated using 3mm ETT and rocuronium. Afterwards he was loaded with KEPPRA at 30mg/kg. Head CT was negative on the way to the ICU. UA negative. UCx and BCx were collected and pt given to ROCEPHIN. In the ICU, patient was continued on a VERSED drip. He appeared stable. He did have episodes of myoclonus. vEEG was obtained. I conducted a lumbar puncture. Prior to LP, patient had an episode of myoclonus followed by tonic clonic activity for which he received aditional VERSED. Discussed the results with neurology. His myoclonus is not seizure activity however tonic clonic activity was a seizure. He continued to have a foci of activity that was central and it was recommended he receive 20mg/kg of phenobarbital." Upon admission patient was initially transferred to the PICU. Pediatric Neurology was consulted who recommended an EEG and MRI Brain. The patient was placed on continuous vEEG and initially kept on a versed drip while intubated pending completion of MRI. MRI was completed without difficulty and resulted as normal; vEEG was completed while on VERSED drip and found to be abnormal. Findings were suggestive of focal neuronal dysfunction of the bitemporoparietal regions with an underlying mild-moderate, nonspecific encephalopathy, therefore per recommendations the patient was started on maintenance KEPPRA 20mg/kg BID. Patient was without recurrent encephalopathy or return of seizures therefore was extubated later that evening on 02/10. Patient was extubated following the MRI, unfortunately he had significant stridor, increased work of breathing, and hypoxemia following extubation which did not improve after Racemic Epi, DECADRON, or High Flow Nasal Cannula therefore the patient was reintubated. He remained stable and was continued on DECADRON, he was again extubated on 02/12 without any further difficulty or respiratory distress. Infectious disease work-up continued to be reassuring including blood, urine, and CSF cultures with no growth to date as well as negative HSV and Enterovirus CSF PCR's. Patient was transferred to the floor where he remained stable with no further seizure activity. On day of discharge, he was afebrile and hemodynamically stable on RA and tolerating PO with adequate urine output. He had no seizures further seizures, antiepileptic therapy of KEPPRA 20mg/kg BID that was initiated. Patient subsequently had another occurrence of complex febrile seizures on August 20, 2017 related to strep throat. On January 4, 2018, patient passed away in his sleep. Autopsy report- cause of death related to seizure disorder.