All cases

• Name/Age/Sex/Address Outcome
Diagnosis

• X/2 yo/F/Bantul Estela 1A

Aplastic anemia
Contoh format
Interesting case
 Wednesday, February 21th 2018

Interesting Point
Headline

How to establish the diagnosis of

afebrile seizure in children ?
Febi, Budi, Winda Intan (Iin) Denta, Ulfa, Giggy
 RA, F, 1yo, Bantul Winda Intan
• Referral case from RSU PKU Bantul

• Chief complain: seizure

4 DBA History of Present illness
At Home On Admission
Seizure
General tonic clonic
Seizure more than 1 time At Emergency Unit Sardjito
>30 minutes Seizure 5 minutes
Fever (-), vomit (-), trauma (-), Stopped by Diazepam supp. (2nd)
other symptoms to include and
exclude other diagnosis

At Emergency unit PKU Bantul

Seizure still persist
Stopped by diazepam supp. (1x) MELATI 2
Dx  epileptic state
Refer to Sardjito Hospital
2 Hours BA
 PERSONAL HISTORY
 No history of previous seizure

 History of head trauma, 10 days ago, the patient fell out of the bed with his head banged on the floor
about height 30cm, no decreasing level of consiousness and vomitus after the fall.  TIDAK PERLU
DITULIS

 History of febrile seizure in family: uncle’s patient

 Antenatal, natal and perinatal history is good, no complications during perinatal period, normal birth
weight

 Growth and developmental according to age

 Basic immunization according to age

 PHYSICAL EXAMINATION
• General appearances : weak • Abdomen : abdominal enlargement,
• PCS : E4M5V6, compos mentis normal peristaltic sound, no abdominal
• Vital Sign pain, no muscular defence, no liver and
– HR : 121 x/minute lien enlargement
– RR : 30 x/minute • Extremities : warm, strong palpable
– T : 36.8oC pulse, CRT < 2”, no edema extremities
– SpO2 : 99% Room Air
• Integument : multiple macular
 Head : no anemic conjunctiva, no
hypopigmentation on the chest, back
icteric sclerae, PUPIL (?), OPTHALMOSKOP ? and armpits
 Neck : no lymph node enlargement, no
increase jugular vein pressure, MS (?)
 Thorax : symmetrical, no retraction
 Lung : normal vesicular sound on both
lungs, no crakles, no wheezing
 Heart : single S1, S2 split inconsistently,
no murmur
 NUTRITIONAL STATUS

 Weight/Height/Head : 5.5 kg/64 cm/41 cm

 WAZ : Z < -3
 HAZ : -2< Z < -3
 WHZ : -3 < Z < -2

• Severely underweight, Stunted, Undernourished

Mild to Moderate Malnutrition

 NEUROLOGICAL EXAMINATION
• Meningeal sign: Neck stiffnes (-) Kernig’s sign (-) Brudzinski (-)
Leg Arm
Right Left Right Left
Movement Free Free Free Free
Strenght 5 5 5 5
Trophy Eutrophic Eutrophic Eutrophic Eutrophic
Tonus Normal Normal Normal Normal
Physiological reflex Increase Increase Increase Increase
Pathological reflex Negative Negative
Sensibilitas Normal Normal Normal Normal
Clonus absent absent

Upper Motor Neuron Lesion

 LABORATORY EXAMINATION –yang relevan saja
Parameters Result Units Normal Value
Erythrocyte 4.82 3,9-5,9
Hemoglobin 11.3 g/dL 11,5 - 16,5
Hematocrit 33.0 % 34 – 48
Leukocytes 9.240 /mm3 4.500 – 11.000
Platelet 349.000 /mm3 150.000-450.000
Neutrophils 37.6 % 50-70
Lymphocytes 57.8 % 22-40
Monocytes 4.2 % 2-8
Eosinophils 0.2 % 2-4
Basophil 0.2 % 0-1
MCV 68.5 fL 80-99
MCH 23.4 pg 27-32
MCHC 34.2 g/dL 32-36
RDW 15.0 % 11,5-14,5

Anemia Mikrositik Hipokromik

 LABORATORY EXAMINATION
Parameters Result Units Normal Value

BUN 9.10 mg/dL 6.00-20.00

Creatinine 0.29 mg/dL 0.50-0.90

Sodium 143 mmol/L 136-145

Potassium 4.66 mmol/L 3.50-5.10

Cloride 109 mmol/L 98-107

Calcium 2.69 mmol/L 2.15-2.55

NORMAL
 DATA LIST AND DIAGNOSIS
No Data list Diagnosis

1. - Male, 5 months Epileptic state cb tuberous sclerosis susp

-First episode of dd neurofibromatosis
afebrile seizure, dd intracranial haemmoraghic
lasting more than 30
minutes
- Multiple macular
hypopigmentation on
the chest, back and
armpits
No Data list Diagnosis
2. Severely Mild to moderate malnutrition
underweight,
Stunted,
Undernourished

3. Low Hb, low MCV, Anemia microcytic hypochromic

low MCHC
 Management and further investigations
• Medication
Interesting point
 int
Key po
of the
case
LESSONS LEARNED

• The best-known afebrile seizure with cutaneus lessions is

Tuberous sclerosis complex.
• Anticonvulsant drug as first line therapy, corticotropin agents
can be considered if there was intractable epilepsy in this case.
REFERENCE
THANK YOU