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 congestion.

PMH: Normal development, one previous episode of otitis media.

Medications: none

Allergies: NKDA

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.

Physical:
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 with stimulation.
HEENT: Nasal congestion, tympanic membranes are red and dull.
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 are downgoing.
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.