California Digital Library
- Author(s): Author, Sam
- et al.
History: 2-month premature infant presented with rhythmic jerking of all 4 extremities at age two weeks. He had been born by Caesarian section at age 30 weeks, due to fetal bradycardia and underlying subchorionic hemorrhage. His hospital course was complicated by Group B Streptococcus pneumonia, for which he received 10 days of ampicillin and gentamicin. He also had anemia of prematurity (treated with packed red blood cells) and thrombocytopenia. Three days before the seizure, his CRP and WBC were noted to be elevated, with a marked shift to the left.
Physical exam: Afebrile, with blood pressure of 60/36, pulse of 187, and respiratory rate of 51. The patient appeared lethargic, with arms and legs were flexed. He was able to move all four extremities, jerking them in clusters of 3 to 5 jerks, every 10 to 20 seconds. Jerking was most pronounced in the upper extremities. Hypertonia was noted between episodes, especially at the right lower extremity. The anterior fontanelle was soft, and deep tendon reflexes were normal. The grasp reflex was weak and inconsistent.
Differential diagnosis: Seizures secondary to hypoxic-ischemic encephalopathy, hemorrhage, meningitis/cerebritis, mass, seizure disorder, toxic/metabolic encephalopathy, accidental trauma, non-accidental trauma.