Can seizures be the sole manifestation of meningitis in febrile children?
OBJECTIVE
It is frequently taught that lumbar puncture is a mandatory procedure in many or all children who have fever and a seizure, because the convulsion may represent the sole manifestation of bacterial meningitis. We attempted to determine the incidence of this occult manifestation of meningitis.


METHODS
Retrospective case series.


METHODS
503 consecutive cases of meningitis in children aged 2 months to 15 years seen at two referral hospitals during a 20-year period.


METHODS
Signs and symptoms of meningitis in patients having associated seizures.


RESULTS
Meningitis was associated with seizures in 115 cases (23%), and 105 of these children were either obtunded or comatose at their first visit with a physician after the seizure. The remaining 10 had relatively normal levels of consciousness and either were believed to have viral meningitis (2) or possessed straightforward indications for lumbar puncture: nuchal rigidity (6), prolonged focal seizure (1), or multiple seizures and a petechial rash (1). No cases of occult bacterial meningitis were found.


CONCLUSIONS
In our review of 503 consecutive children with meningitis, none were noted to have bacterial meningitis manifesting solely as a simple seizure. We suspect that this previously described entity is either extremely rare or nonexistent. Commonly taught decision rules requiring lumbar puncture in children with fever and a seizure appear to be unnecessarily restrictive.
Green
S M
SM
Department of Emergency Medicine, Riverside General Hospital, California 92503.
Rothrock
S G
SG
Clem
K J
KJ
Zurcher
R F
RF
Mellick
L
L
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003128:Coma / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D016920:Meningitis, Bacterial / Q000150:complications* / Q000453:epidemiology; D012189:Retrospective Studies; D012640:Seizures / Q000453:epidemiology / Q000209:etiology*; D013129:Spinal Puncture; D013997:Time Factors