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A Previously Healthy Adolescent With Acute Encephalopathy and Decorticate Posturing
- Source :
- Pediatrics. 139
- Publication Year :
- 2017
- Publisher :
- American Academy of Pediatrics (AAP), 2017.
-
Abstract
- A 14-year-old previously healthy female was transferred from a local emergency department after being found unresponsive at home. Parental questioning revealed she had fever and pharyngitis 2 weeks before presentation. Past mental health history was negative, including concern for past or present suicidal ideation/attempts, suspected substance use, or toxic ingestion. In the emergency department, she was orotracheally intubated due to a Glasgow Coma Scale of 3. She was hemodynamically stable and euglycemic. Electrocardiogram showed sinus tachycardia. She underwent a noncontrast head computed tomography that was normal and subsequently underwent a lumbar puncture. She had a seizure and was given a loading dose of diazepam and fosphenytoin that led to cessation of extremity movements. She was subsequently transferred to the PICU for additional evaluation. Initial examination without sedation or analgesia demonstrated dilated and minimally responsive pupils, intermittent decorticate posturing, and bilateral lower extremity rigidity and clonus, consistent with a Glasgow Coma Scale of 5. Serum studies were unremarkable with the exception of mild leukocytosis. Chest radiograph only showed atelectasis. She was empirically started on antibiotics to cover for meningitis pending final cerebral spinal fluid test results. The pediatric neurology team was consulted for EEG monitoring, and the patient was eventually sent for computed tomography angiogram and magnetic resonance angiogram/venogram. We will review diagnostic evaluation and management of an adolescent patient with acute encephalopathy with decorticate posturing of unclear etiology.
- Subjects :
- Serotonin Syndrome
medicine.medical_specialty
Adolescent
Sinus tachycardia
Amitriptyline
Suicide, Attempted
Atelectasis
Self Medication
Intensive Care Units, Pediatric
030218 nuclear medicine & medical imaging
Diagnosis, Differential
03 medical and health sciences
0302 clinical medicine
medicine
Acute Febrile Encephalopathy
Humans
Glasgow Coma Scale
Bupropion
Intersectoral Collaboration
Decerebrate State
Pediatric intensive care unit
medicine.diagnostic_test
Lumbar puncture
business.industry
Venlafaxine Hydrochloride
Brain
Emergency department
medicine.disease
Magnetic Resonance Imaging
Surgery
Anesthesia
Pediatrics, Perinatology and Child Health
Female
Interdisciplinary Communication
medicine.symptom
Emergency Service, Hospital
Tomography, X-Ray Computed
business
Chest radiograph
Meningitis
Magnetic Resonance Angiography
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 10984275 and 00314005
- Volume :
- 139
- Database :
- OpenAIRE
- Journal :
- Pediatrics
- Accession number :
- edsair.doi.dedup.....4fcd9c9626577d00b184728c3e2fdb8f