The patient is a 14-month-old boy who presents with a 30-minute convulsion
that starts in the right arm and leg and then secondarily generalizes.
He had been fussy for the previous six hours and had developed cough and
PMH: Normal development, one previous episode of otitis
Family History: Six-year old sister had a similar but
shorter event when she was 16 months of age.
Social History: The boy lives with his parents and sister.
Both parents are employed.
BP 100/70 HR 145
T 39.4°C RR 30
General: Weight, length and head circumference are at
the 50th percentiles. The boy is not dysmorphic.
Mental Status: Sleepy 14 month old boy who can be aroused
HEENT: Nasal congestion, tympanic membranes are red and
Motor (Power/Tone/Bulk): Mild hypotonia of trunk and limbs. Strong
movements against gravity when stimulated, but movements are less on the
right side. Bulk is normal.
Sensory: Withdraws to noxious stimuli.
Reflexes: Normal in arms and legs. Plantar responses
Coordination: Too sleepy to assess.
Gait: Too sleepy to assess.
Abnormal Movements: None.
Other Organs: Skin is flushed, but there is no rash and
no birthmarks. There is no nuchal rigidity.