Abstract
An eight-year-old boy presented to the emergency department for a first-time seizure. The patient had only signs of mild dehydration on physical exam and had an uneventful postictal recovery. First-time seizures in pediatric patients are often benign and require only an outpatient workup; some are dangerous. This case takes the reader through the differential diagnosis and systematic work-up of new-onset pediatric seizures, leading to an unanticipated diagnosis.
Highlights
An eight-year-old boy presented to the emergency department for a first-time seizure
What am I missing? There must be more to this than meets the eye. He presented after a witnessed seizure at home, accompanied by incontinence, and followed by a postictal period
The seizure was preceded by upper respiratory infection symptoms and decreased oral intake
Summary
An eight-year-old boy presented to the emergency department for a first-time seizure. CASE PRESENTATION An eight-year-old African-American male was brought to the emergency department (ED) by ambulance after a first-time, witnessed seizure at home. Some elements of the current presentation are consistent with an anticholinergic overdose, such as the AMS, tachycardia and dry mucous membranes, others are not, including the patient’s pupillary exam.
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