Differential Diagnosis for convulsions (fits) for a child

This post mainly consist differential diagnosis and how it can differentiate

Meningitis / Encephalitis

• Fever,
• Drowsines,
• Irritabilit,
• Photo phobi,
• History of upper respiratory track infection or Ear discharge
• Purpuric skin rashers (Neisseria meningitidis)
• Neck stiffness
• Skin infection (Staphylococcus aureus)

Tuberculous Meningitis

• Contact history of Tuberculosis
• BCG scar
• Mantoux test

Cerebral malaria

• Travel to malaria endemic erea
• Fever with chills and rigours

Febrile convulsions 

  A febrile convulsion is a seizure that occur between the age of 3 months to 6 years with fever that is not result of central nervous system infection or any metabolic imbalance, and that occur in the absence of a history of prior afebrile seizures.

• Benign
• Occur with fever
• Age 6 month to 5 years
• Less postictal drowsiness
• Usually less than 15 min ( if more than it, It is a complex febrile convulsions.)

Difference of simple and complex febrile convulsions

Simple febrile convulsion

• Less than 15 minutes (few seconds)
• Primary generalized 
• Usually tonic clonic
•  Not recurrent within a 24 hour period
• Chance of developing subsequent epilepsy is not increased. Same as all children (1- 2%). 

Complex febrile convulsion

• Continue more than 15 minutes,
• Focal,
• Recurs within 24 hours,
• Chance of developing subsequent epilepsy is increased. (4- 12%)

Epilepsy

• Long postictal drowsiness
• Past history of convulsions
• Antyepileptic drug withdrawal
• Neurocutaneous markers on skin

       pic.1 cafe au lait patches,(black arrows) neurofibroma (white)

Metabolic causes

• Hypoglycemia
• fasting, associated with sweating
• Hyponatraemia
• vomiting, diarrhea

Head trauma

Toxins and drugs