TODDLER WITH FEBRILE SEIZURES OR HEART BLOCK? AN INTERESTING CASE REPORT IN PEDIATRICS.

Introduction: Stokes-Adams syndrome characterizes a primary mechanism of syncope stemming from cardiac origins, resulting from disruptions in cardiac rhythm. These rhythm disturbances can manifest as either a fast or slow heart rate, presenting as either regular or irregular patterns. Case Report: A three-year-old patient was admitted to the hospital due to experiencing myoclonus, gaze fixation and fever. These symptoms were preceded by episodes of vomiting. Upon admission, the family reported that the child had experienced self-limited generalized tonic-clonic seizures lasting 3-4 minutes. The child's grandfather, who has medical experience, likened the convulsions to a myocardial infarction. Following the convulsive episode, the patient's status reveals pupils of equal size and preserved photomotor reflex. Initially, the diagnosis of generalized febrile convulsions might be considered, but upon examination, additional changes were identified. The clinical examination shows rhythmic heart sounds, a low ventricular rate of 48 beats per minute, a systolic murmur at the mitral valve, warm extremities and a congested pharynx. The electrocardiogram indicates a third-degree atrioventricular block along with severe bradycardia and a prolonged QT interval (QTc = 0.50second). The cardiac ultrasound shows the ejection fraction of the left ventricle measuring 55% and no abnormalities in the cardiac structure are found. The treatment administered included a 1000 ml intravenous infusion of glucose and electrolytes per 24 hours, 40 ml of 15% mannitol, cortisone hemisuccinate and 0.5 ml per day of intramuscular phenobarbital 10%. The patient's condition showed improvement with no recurrence of syncopal episodes. Bradycardia persisted at 46 beats per minute with a slight tendency to increase upon mobilization. The electrocardiogram continues to exhibit the same changes during hospitalization. Discussions : In this case, initially, bradycardia was linked with acute cerebral edema following a seizure, a connection that might have postponed the pacemaker implantation procedure. Given the potential severity of the case, the patient is promptly referred for pacemaker implantation. In children, third-degree atrioventricular block can stem from congenital or acquired type. In the absence of congenital heart defects, the congenital type is often associated with neonatal lupus erythematosus. Other causes include cardiomyopathies, Lyme carditis, acute rheumatic fever or myocarditis. Conclusions: Severe bradycardia, third-degree atrioventricular block type and long QT intervals led to the interpretation of the convulsive crisis as cardiac syncope. A potential congenital origin is suspected. Additionally, the parents noted reduced and irregular heart sounds since infancy. Neither parent has a known history of heart disease. [ABSTRACT FROM AUTHOR]