A 5-year-old fully immunized girl with a history of tuberous sclerosis, localization-related epilepsy with remote resection of a seizure focus, developmental delay, oral aversion with gastrostomy tube dependence, and necrotizing pancreatitis presents with reported episodes of gait instability and altered mental status described as her head falling down, sudden diffuse loss of muscle tone, and unresponsiveness lasting 15 to 45 seconds. During the past few hours, the mother has noticed that the child appears wobbly. She had 1 episode of wobbliness with subsequent fall but denies any head injury, loss of consciousness, or tonic-clonic movements. On presentation to the emergency department she had 2 additional episodes of hypotonia and unresponsiveness to verbal stimuli lasting less than 1 minute. She had not recently missed any of her antiepileptic medications, which included levetiracetam, perampanel, vigabatrin, and taurine. In addition, her medications had not been changed in the past 6 months. Due to...
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October 2020
Index of Suspicion|
October 01 2020
Altered Mental Status in a 5-year-old Girl
Tara M. Kopp, MD, MS;
Tara M. Kopp, MD, MS
*Department of Pediatrics, University of Louisville, Louisville, KY
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Jacob M. Redel, MD;
Jacob M. Redel, MD
†Division of Endocrinology, Children’s Mercy Hospital, Kansas City, MO
‡Department of Pediatrics, School of Medicine, University of Missouri-Kansas City, Kansas City, MO
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Holly E. Depinet, MD, MPH
Holly E. Depinet, MD, MPH
§Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
¶Department of Pediatric, College of Medicine, University of Cincinnati, Cincinnati, OH
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AUTHOR DISCLOSURE
Drs Kopp, Redel, and Depinet 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.
Pediatr Rev (2020) 41 (10): 546–548.
Citation
Tara M. Kopp, Jacob M. Redel, Holly E. Depinet; Altered Mental Status in a 5-year-old Girl. Pediatr Rev October 2020; 41 (10): 546–548. https://doi.org/10.1542/pir.2018-0160
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