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Pediatrics. 1993 Oct;92(4):527-34.

Can seizures be the sole manifestation of meningitis in febrile children?

Author information

1
Department of Emergency Medicine, Riverside General Hospital, California 92503.

Abstract

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.

DESIGN:

Retrospective case series.

SETTING AND PATIENTS:

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

MAIN OUTCOME MEASURES:

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.

CONCLUSION:

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.

PMID:
8414822
[Indexed for MEDLINE]

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