Case 4: An Infant with Status Epilepticus and Stroke

Presentation

A 33-day-old boy is admitted to the hospital with seizure episodes. The antenatal course was complicated by gestational diabetes mellitus and group B streptococcus (GBS) urinary tract infection for which the mother received intrapartum antibiotic drug therapy. The patient was born at term by induced vaginal delivery because of prolonged rupture of membrane but with Apgar scores of 8, 9, and 9 at 1, 5, and 10 minutes, respectively, without any birth asphyxia, meconium aspiration, and nuchal cord. On the day of admission, the patient started having tonic-clonic movement involving the left upper extremity associated with left arm extension, fisting of the left hand with squeezing movement, and eye deviation to the left associated with grunting. He continues to have seizures until he is given 4 doses of intravenous lorazepam 0.1 mg/kg, a loading dose of levetiracetam 20 mg/kg intravenously, and phenobarbital 20 mg/kg intravenously. He also presents with fever (rectal temperature of 102.9°F [39.4°C]), which is treated with 10 mg/kg of rectal acetaminophen twice.

On examination, peripheral capillary refill is 3 seconds. He has no spontaneous eye opening but is responding to painful stimuli. The anterior fontanelle is bulging, and pupils are 2 mm and reacting normally. Funduscopic examination did not show retinal hemorrhage, but optic disc margins were not clear bilaterally. Movement is diminished overall, but no movement of the left upper and lower extremities is present. The Moro reflex is incomplete, but rooting and sucking reflexes are present. Four beats of ankle …