title: A Previously Healthy Adolescent With Acute Encephalopathy and Decorticate Posturing.
abstract: A 14-year-old previously healthy female was transferred from a local emergency department after being found unresponsive at home. Parental questioning revealed she had fever and pharyngitis 2 weeks before presentation. Past mental health history was negative, including concern for past or present suicidal ideation/attempts, suspected substance use, or toxic ingestion. In the emergency department, she was orotracheally intubated due to a Glasgow Coma Scale of 3. She was hemodynamically stable and euglycemic. Electrocardiogram showed sinus tachycardia. She underwent a noncontrast head computed tomography that was normal and subsequently underwent a lumbar puncture. She had a seizure and was given a loading dose of diazepam and fosphenytoin that led to cessation of extremity movements. She was subsequently transferred to the PICU for additional evaluation. Initial examination without sedation or analgesia demonstrated dilated and minimally responsive pupils, intermittent decorticate posturing, and bilateral lower extremity rigidity and clonus, consistent with a Glasgow Coma Scale of 5. Serum studies were unremarkable with the exception of mild leukocytosis. Chest radiograph only showed atelectasis. She was empirically started on antibiotics to cover for meningitis pending final cerebral spinal fluid test results. The pediatric neurology team was consulted for EEG monitoring, and the patient was eventually sent for computed tomography angiogram and magnetic resonance angiogram/venogram. We will review diagnostic evaluation and management of an adolescent patient with acute encephalopathy with decorticate posturing of unclear etiology.
authors.affiliation: Divisions of Pediatric Critical Care Medicine and kawai.yu@mayo.edu.
authors.forename: Yu
authors.initials: Y
authors.lastname: Kawai
authors.affiliation: Divisions of Pediatric Critical Care Medicine and.
authors.forename: Andrea G
authors.initials: AG
authors.lastname: DeMonbrun
authors.affiliation: Divisions of Pediatric Critical Care Medicine and.
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Chambers
authors.affiliation: Pediatric Neurology, Department of Pediatrics and Communicable Diseases.
authors.forename: Danielle A
authors.initials: DA
authors.lastname: Nolan
authors.affiliation: Division of Toxicology, Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Bram A
authors.initials: BA
authors.lastname: Dolcourt
authors.affiliation: Division of Child and Adolescent Psychiatry, Department of Psychiatry, and.|Department of Pediatrics and Communicable Diseases, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan; and.
authors.forename: Nasuh M
authors.initials: NM
authors.lastname: Malas
authors.affiliation: Divisions of Pediatric Critical Care Medicine and.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Quasney
mesh_terms: D000071072:Acute Febrile Encephalopathy / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D000293:Adolescent; D000639:Amitriptyline / Q000031:analogs & derivatives* / Q000633:toxicity; D001921:Brain / Q000000981:diagnostic imaging; D016642:Bupropion / Q000633:toxicity*; D003655:Decerebrate State / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000209:etiology*; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015278:Intensive Care Units, Pediatric; D033183:Interdisciplinary Communication; D000070516:Intersectoral Collaboration; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D012651:Self Medication; D020230:Serotonin Syndrome / Q000175:diagnosis*; D013406:Suicide, Attempted / Q000517:prevention & control; D014057:Tomography, X-Ray Computed; D000069470:Venlafaxine Hydrochloride / Q000633:toxicity*
chemical_list: D016642:Bupropion; D000639:Amitriptyline; C004704:cyclobenzaprine; D000069470:Venlafaxine Hydrochloride