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Thyroid storm, an extreme manifestation of hyperthyroidism, is very rare because hyperthyroidism is usually treated successfully with medication. (In hyperthyroidism the thyroid gland secretes excessive amounts of thyroid hormone, which increases the body's metabolism.) While rare in adults, thyroid storm is even more unusual in children. However, thyroid storm can still occur in patients whose thyroid condition is not well controlled, or who are subjected to extreme physical stress, such as a serious infection. Typical symptoms include a high fever, increased heart rate, neurologic symptoms, jaundice (yellow skin), and digestive problems, such as vomiting and diarrhea. The case of a 3.5-year-old girl who developed thyroid storm is described. Her earliest signs of hyperthyroidism, which were not initially recognized as symptoms of illness, included greatly increased appetite, protruding eyes, and intolerance to heat. Even though it was winter, the child would not wear warm clothing, and she ate as much as an adult. Although she had been fine when she went to bed, the child became seriously ill overnight. In the morning her parents could not wake her. At the hospital she was found to be in a coma, and to have greatly elevated blood pressure, temperature and heart rate, dilated pupils, and difficulty breathing, which necessitated the use of a respirator. The patient was transferred to a medical center where physicians noted that she had an enlarged thyroid gland. Her blood level of thyroxine, a thyroid hormone, was elevated. Thyroid storm was diagnosed and medication therapy was begun. She was also treated for seizures, which began soon after her transfer to the medical center. Within two days, the child was much improved. She was taken off the respirator and regained alertness, but remained irritable and had some trouble remembering names. By the time that she was discharged from the hospital, all her neurologic problems had resolved. She was maintained on antithyroid medication. The various diagnostic tests that were performed and treatments are discussed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Many patients with the acquired immunodeficiency syndrome (AIDS) have generalized seizures which is a common complication of a human immunodeficiency virus infection (HIV). Seizures can occur when bacterial, viral, and fungal infections or tumors are present in the brain. Seizures are also associated with AIDS-related dementia. This case study describes seizures in two patients who had no evidence of infection or other lesions in the brain. A 33-year-old woman with a history of intravenous drug use tested positive for HIV antibodies for two years. The patient was found in her home and was unresponsive; she had apparently been vomiting. After arriving in the emergency room, seizure activity was noticed in the right arm and leg. A 22-year-old homosexual man had a tonic-clonic seizure which lasted two to three minutes. Prior to the seizure the patient perceived the smell of burning rubber. In both cases, the seizures appeared early in the disease and were easily controlled with diphenylhydantoin antiseizure medication. Although both patients reported some memory impairment, they did not have overt signs of dementia, a progressive mental disorder, or evidence of a localized brain infection. Computerized tomography (CT) scans, detailed cross sectional X-ray's, were normal in one patient and showed slight brain atrophy in the other patient. It was concluded that seizures can occur in early stages of AIDS even if there is no evidence of brain lesions. (Consumer Summary produced by Reliance Medical Information, Inc.)

A 35-year-old pregnant woman developed sudden headaches and seizures at 24 weeks gestation. Magnetic resonance imaging revealed a cavernous angioma in the brain, a rare vascular malformation that often produces no symptoms. The tumor was not amenable to surgical correction, and the patient was treated with phenytoin to control the seizures. She delivered normal twins, and remains seizure-free with drug therapy.

Some patients taking piperacillin as an antibiotic may, under certain circumstances, experience seizures. An 11-year-old patient recently treated with chemotherapy for leukemia was treated with piperacillin for two blood infections. The patient had seizures on two separate occasions. Both seizures occurred two hours after taking the morning antibiotic treatment and lasted for two to three minutes. There was no indication of brain abnormalities or meningitis as seen on brain scans and in spinal fluid tests, respectively. The patient had no more seizures after changing medication.

It is not uncommon for episodic phenomena in infancy to be mistaken for signs of epilepsy. Paroxysmal torticollis is a benign, self-limited disorder in which episodes of sudden, stereotyped head-tilting recur; it is often associated with pallor, agitation, nystagmus and emesis. The frequency of the episodes vary, and if they are brief, they can be mistaken for seizures. A case of paroxysmal torticollis in a 3-month-old infant is reported. The patient's past medical history was unremarkable, and there was no family history of epilepsy or other paroxysmal disorders. She was alert upon admission and suffered no further episodes during the 2 days she was hospitalized. Two weeks later, she was reevaluated on an emergency basis when the same events recurred. After a neurologic examination and performance of the Hallpike maneuver by the examining physician, she was diagnosed with paroxysmal torticollis. It is important for physicians to recognize this disorder so that costly, incorrect treatment can be avoided.

Some simple guidelines that should be followed if faced with a person experiencing a seizure are presented.

When infants lose significant quantities of water due to intestinal infections, there is a risk of hypernatremic dehydration (insufficient water associated with high levels of sodium). When rehydrating the patient (re-establishing normal water balance), it is possible to give fluids in a manner that causes seizures and may lead to long-term impaired neurological function. It is thought that seizures may occur because of the rate of decrease in the sodium level in the blood. A case study describes a three-month-old female infant, who had a two-day history of watery diarrhea, which was preceded by four days of poor eating, fussiness, and decreased urine output. The infant was found to be dehydrated and she was rehydrated by intravenous fluid administration. Shortly thereafter, the patient developed seizures, which were difficult to control, but eventually treated successfully. Her blood sodium level was normal when measured after the seizure. Subsequent rehydration was accomplished slowly. Hypernatremic dehydration, which can be recognized by signs of central nervous system dysfunction, should be corrected slowly. The recommended rate of intravenous fluid administration is no faster than 0.5 mEq per liter per hour, a rate that was exceeded by a factor of seven in this patient. Additional water administered by the mother further complicated this too-rapid rehydration. (Consumer Summary produced by Reliance Medical Information, Inc.)

San Juan, P.R. -- Seizures in older adults have a different presentation than they do in younger patients, with these events resembling many other conditions and making diagnosis difficult, but [...]

Children younger than 16 years who suffered unprovoked seizures were 2.5 times more likely to have a parent-reported history of attention-deficit hyperactivity disorder, compared with controls, said Dale C. Hesdorffer, [...]

SAN FRANCISCO -- A healthy newborn whose arm starts shaking uncontrollably probably is having a stroke, which is causing the focal seizure, Dr. Donna M. Ferriero said at a press [...]

BANFF, ALTA. -- Neurocysticercosis should be considered in any pregnant patient presenting with seizures that can't be explained by epilepsy or preeclampsia, Dr. Jeanne S. Sheffield said at the annual [...]

Background: Aniseed oil has been used historically as a homeopathic remedy for cough, bronchitis, colic and other dyspeptic conditions. It has been referenced in literary works from Virgil to St. Matthew and is commonly used in folk medicine. Aniseed oil is extracted from the fruit of the Pimpinella anisum plant. The active component, trans-anethol constitutes approximately 90% of the volatile oil. The tea is traditionally made by diluting 2 teaspoons of oil in 1 pint of boiling water. The usual dose in infants for colic is one teaspoon of the tea. Case Report: A 12-day-old infant presented to the Pediatric Emergency Department with generalized tonic-clonic seizures. The infant had an unremarkable history except that he had unintentionally received multiple doses of undiluted aniseed oil by the parents as a treatment for colic. A complete blood count, electrolytes, spinal fluid analysis with culture, blood cultures, CT scan of the brain, and EEG were all normal. No further seizure activity was noted after admission to the hospital. The infant subsequently recovered with no further sequelae reported. Conclusion: We report a case of seizures in an infant temporally related to the ingestion of aniseed oil and no other explanation for the seizure activity. A literature search did not reveal other documented cases of aniseed toxicity in infants. Physicians should be aware of possible toxic syndromes resulting from ingestion of aniseed oil and other herbal supplements., Tuckler V, Peck C, Nesbitt C, Coleman M, Weimer S, Martinez J, Ryan M, and Arnold T. Medical Center of Louisiana at New Orleans--University Hospital and the Louisiana Poison Control [...]

PHILADELPHIA -- An ictal motor behavior that starts, stops, and then resumes can help distinguish nonepileptic spells from true seizures. Such restarting ictal motor behaviors, known as the reprise phenomenon, [...]

To the Editor: Thank you to Drs. Heard, O'Malley, Dart, and Smith[1] for their interest.[2] In their letter they state that, in the case I described, the only finding that [...]

Background: Benzonatate is an antitussive with a unique chemical structure. It can contain as many as 8 structural analogs. Therefore, laboratory analysis of benzonatate is difficult. We report 2 cases of benzonatate poisoning with seizures and cardiac arrest and an analytical method to identify and quantify benzonatate in human plasma. Case Reoorts: Case 1: A 12-month-old male presented to the emergency department of a rural hospital following ingestion of an unknown amount of benzonatate. Upon arrival, the child was seizing and in full cardiac arrest. Resuscitative measures were unsuccessful and the child died shortly after arriving at the emergency department. Case 2: A 39-year-old male ingested 36 benzonatate capsules in a suicide attempt. Enroute to the health care facility, the patient experienced a seizure, had a cardiac arrest, and was cardioverted. Upon arrival at the emergency department, the patient was acidotic with a pH of 6.8. Gastric lavage was performed followed by the administration of activated charcoal. Six hours after arrival at the emergency department, the patient was alert, oriented, and hemodynamically stable. The patient was observed for 24 hours and subsequently discharged. Laboratory confirmation of benzonatate in the plasma of the patient was performed using high-pressure liquid chromatography with tandem mass spectrometry (MS/MS). The benzonatate concentration was estimated to be 2.5 [micro]g/mL. Conclusion: Seizures and cardiac arrest are possible following an acute ingestion. Quantitative analysis of benzonatate is possible using high-pressure liquid chromatography with tandem mass spectrometry. Routine analysis for benzonatate is not common., INTRODUCTION Benzonatate is an antitussive available by prescription in 100 mg liquid-filled capsules containing parabens as a preservative. The usual dose of benzonatate is 100 mg 3x/d, although it is [...]

Dear Dr. Cory: I have a question I hope you can answer. I've been asking my mom about seizures. One of my classmates has them and that's why I'm interested. […]