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American Academy of Pediatrics
Index of Suspicion

Case 3: Seizure, Facial Droop, and Altered Mental Status in a 9-year-old Girl

Flora Nuñez Gallegos, Daniel A. Castellanos, Michiaki Imamura and William B. Kyle
Pediatrics in Review June 2020, 41 (6) 300-302; DOI: https://doi.org/10.1542/pir.2018-0102
Flora Nuñez Gallegos
*Department of Pediatrics,
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Daniel A. Castellanos
†Division of Cardiology, Department of Pediatrics, and
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Michiaki Imamura
‡Division of Congenital Heart Surgery, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX
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William B. Kyle
†Division of Cardiology, Department of Pediatrics, and
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  1. Flora Nuñez Gallegos, MD, MPH*
  2. Daniel A. Castellanos, MD†
  3. Michiaki Imamura, MD‡
  4. William B. Kyle, MD†
  1. *Department of Pediatrics,
  2. †Division of Cardiology, Department of Pediatrics, and
  3. ‡Division of Congenital Heart Surgery, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX
  • AUTHOR DISCLOSURE

    Drs Gallegos, Castellanos, Imamura, and Kyle have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Presentation

A previously healthy 9-year-old girl presents to the emergency department after an episode of generalized shaking, urinary incontinence, and altered mental status. The episode occurred while in school, where she was believed to have fallen asleep until clenching of the fists and shaking were noted. The duration of the episode is unknown. In the emergency department her parents note continued drowsiness, slurred speech, left facial droop, and decreased movement of her left arm and leg. She has no history of seizures. However, her parents state that over the past month she has had fatigue and foot pain, with the appearance of red spots on her distal extremities that had resolved. She has had intermittent sensation of coldness to the left ring finger. There has been no recent travel, fever, or head trauma.

Her vital signs on presentation are as follows: respiratory rate, 24 breaths/min; heart rate, 107 beats/min; blood pressure, 106/60 mm Hg; oxygen saturation, 98% on room air; and temperature, 98.4°F (36.9°C). On physical examination she arouses easily from sleep. She is alert and able to follow commands but fatigues quickly. Lungs are clear bilaterally and cardiac examination reveals no murmur. There are no rashes or lesions, although she appears pale. There is mild left nasolabial fold asymmetry and dysarthria. Prosody of speech is apparent, but comprehension remains intact. Pupils are equal, round, and reactive to light. Extraocular …

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Pediatrics in Review: 41 (6)
Pediatrics in Review
Vol. 41, Issue 6
1 Jun 2020
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Case 3: Seizure, Facial Droop, and Altered Mental Status in a 9-year-old Girl
Flora Nuñez Gallegos, Daniel A. Castellanos, Michiaki Imamura, William B. Kyle
Pediatrics in Review Jun 2020, 41 (6) 300-302; DOI: 10.1542/pir.2018-0102

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Case 3: Seizure, Facial Droop, and Altered Mental Status in a 9-year-old Girl
Flora Nuñez Gallegos, Daniel A. Castellanos, Michiaki Imamura, William B. Kyle
Pediatrics in Review Jun 2020, 41 (6) 300-302; DOI: 10.1542/pir.2018-0102
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