[Lumbar puncture and early neuroimaging in complex febrile seizures. Report of a case of shaken infant syndrome]. / Punción lumbar y neuroimagen precoz en las crisis febriles complejas. A proposito de un caso de síndrome de lactante sacudido.

INTRODUCTION: Febrile convulsions are one of the most frequent pathologies seen in paediatric emergencies. The diagnosis of febrile seizures is clinico evolutionary and is easily established once the acute process is overcome and a normal state is restored in the child. The differential diagnosis is established with the processes that associate fever and convulsions in children between the ages of 1 month and 6 years, many of which require specific treatment. Certain complementary examinations, essentially a blood test, lumbar puncture and neuroimaging, are needed to identify them. Shaken infant syndrome is a form of physical abuse which includes the presence of intracranial traumatic injury, retinal haemorrhage and, in general, the absence of other physical signs of traumatic injury in the child. CASE REPORT: An 8 month old infant who presented a convulsive seizure on the left side of the body which coincided with an axillary temperature of 38 C that remitted with intravenous diazepam 40 minutes after onset. An early cranial computerised tomography (CT) scan led to a diagnosis of shaken infant syndrome. DISCUSSION: This case constitutes an argument in favour of performing an early cranial CT scan in complex febrile convulsions and in prolonged or partial non provoked seizures. We highlight the risks involved in performing a lumbar puncture in the absence of suspected non complicated acute bacterial meningitis. The diagnostic usefulness of an early CT scan in diagnosing such an important problem as shaken infant syndrome must also be noted, due to the risk of repetition and its high morbidity and mortality rates.

Punción lumbar y neuroimagen precoz en las crisis febriles complejas. A propósito de un caso de síndrome de lactante sacudido / Lumbar puncture and early neuroimaging in complex febrile seizures. Report of a case of shaken infant syndrome

Introducción. Las convulsiones febriles son una de las patologías más frecuentes de las urgencias pediátricas. El diagnóstico de crisis febril es clinicoevolutivo, y se establece sin dificultad una vez superado el proceso agudo y recuperada la normalidad del niño. El diagnóstico diferencial se establece con los procesos que asocian fiebre y convulsiones en niños entre 1 mes y 6 años de edad, muchos de los cuales precisan un tratamiento específico. Para su identificación es necesaria la realización de determinados exámenes complementarios, fundamentalmente, una analítica sanguínea, punción lumbar y neuroimagen. El síndrome del lactante sacudido es una forma de maltrato físico que incluye la presencia de traumatismo intracraneal, hemorragias retinianas y, en general, la ausencia de otros signos físicos de traumatismos en el niño. Caso clínico. Lactante de 8 meses que presentó una crisis convulsiva hemicorporal izquierda que coincidía con una temperatura axilar de 38 ºC, que cedió con diacepam intravenoso a los 40 minutos del inicio. La tomografía computarizada (TAC) craneal precoz llevó al diagnóstico de síndrome del lactante sacudido. Discusión. El presente caso constituye un argumento a favor de la realización precoz de TAC craneal en las convulsiones febriles complejas y en las crisis no provocadas prolongadas o parciales. Se destacan los riesgos de la realización de punción lumbar en ausencia de sospecha de meningitis bacteriana aguda no complicada. Se destaca el valor diagnóstico de la TAC precoz en un problema tan importante de ser diagnosticado como el síndrome del lactante sacudido, debido al riesgo de repetición y su alta morbimortalidad (AU)

Introduction. Febrile convulsions are one of the most frequent pathologies seen in paediatric emergencies. The diagnosis of febrile seizures is clinico-evolutionary and is easily established once the acute process is overcome and a normal state is restored in the child. The differential diagnosis is established with the processes that associate fever and convulsions in children between the ages of 1 month and 6 years, many of which require specific treatment. Certain complementary examinations, essentially a blood test, lumbar puncture and neuroimaging, are needed to identify them. Shaken infant syndrome is a form of physical abuse which includes the presence of intracranial traumatic injury, retinal haemorrhage and, in general, the absence of other physical signs of traumatic injury in the child. Case report. An 8-month-old infant who presented a convulsive seizure on the left side of the body which coincided with an axillary temperature of 38 ºC that remitted with intravenous diazepam 40 minutes after onset. An early cranial computerised tomography (CT) scan led to a diagnosis of shaken infant syndrome. Discussion. This case constitutes an argument in favour of performing an early cranial CT scan in complex febrile convulsions and in prolonged or partial non-provoked seizures. We highlight the risks involved in performing a lumbar puncture in the absence of suspected non-complicated acute bacterial meningitis. The diagnostic usefulness of an early CT scan in diagnosing such an important problem as shaken infant syndrome must also be noted, due to the risk of repetition and its high morbidity and mortality rates (AU)