Punción lumbar y neuroimagen precoz en las crisis febriles complejas. A propósito de un caso de síndrome de lactante sacudido

Abstract

Febrile convulsions are one of the most frequent pathologies seen in paediatric emergencies. The diagnosis of febrile seizures is clinico evolutionary and is easily established once the acute process is overcome and a normal state is restored in the child. The differential diagnosis is established with the processes that associate fever and convulsions in children between the ages of 1 month and 6 years, many of which require specific treatment. Certain complementary examinations, essentially a blood test, lumbar puncture and neuroimaging, are needed to identify them. Shaken infant syndrome is a form of physical abuse which includes the presence of intracranial traumatic injury, retinal haemorrhage and, in general, the absence of other physical signs of traumatic injury in the child.An 8 month old infant who presented a convulsive seizure on the left side of the body which coincided with an axillary temperature of 38 C that remitted with intravenous diazepam 40 minutes after onset. An early cranial computerised tomography (CT) scan led to a diagnosis of shaken infant syndrome.This case constitutes an argument in favour of performing an early cranial CT scan in complex febrile convulsions and in prolonged or partial non provoked seizures. We highlight the risks involved in performing a lumbar puncture in the absence of suspected non complicated acute bacterial meningitis. The diagnostic usefulness of an early CT scan in diagnosing such an important problem as shaken infant syndrome must also be noted, due to the risk of repetition and its high morbidity and mortality rates.