Child presenting to the ED with prolonged autonomic symptoms followed by generalized seizure activity.
A 5-year-old girl presented to the emergency department (ED) with a parental complaint of vomiting and seizure-like activity. The patient had been in her normal state of health before the onset of this activity and had had no recent illnesses. Shortly after the child had gone to bed, she awoke complaining of feeling sick to her stomach. Over several minutes the child became less responsive to questioning, followed by rightward eye and head deviation and vomiting. Following this, the child's eyes remained fixed in a rightward gaze and she was no longer responsive to questioning despite appearing awake. On the way to the hospital the child became flaccid, which was shortly followed by further vomiting and right upper extremity jerking and finally full upper extremity convulsive activity. In the ED, the child remained in this state for approximately 90 minutes despite the use of intravenous diazepam. Gradually, she became responsive to parental stimulation and questioning.
Department of Emergency Medicine, University of Missouri, Columbia, MO, USA.
Henry
H
David
D001342:Autonomic Nervous System Diseases / Q000150:complications / Q000175:diagnosis*; D002675:Child, Preschool; D004569:Electroencephalography; D004828:Epilepsies, Partial / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006801:Humans; D013577:Syndrome; D014839:Vomiting / Q000209:etiology