Can seizures be the sole manifestation of meningitis in febrile children?

S. M. Green, S. G. Rothrock, K. J. Clem, R. F. Zurcher, L. Mellick

Research output: Contribution to journalArticle

86 Citations (Scopus)

Abstract

Objective. It is frequently taught that lumbar puncture is a mandatory procedure in many or all children who have fever and a seizure, because the convulsion may represent the sole manifestation of bacterial meningitis. We attempted to determine the incidence of this occult manifestation of meningitis. Design. Retrospective case series. Setting and patients. 503 consecutive cases of meningitis in children aged 2 months to 15 years seen at two referral hospitals during a 20-year period. Main outcome measures. Signs and symptoms of meningitis in patients having associated seizures. Results. Meningitis was associated with seizures in 115 cases (23%), and 105 of these children were either obtunded or comatose at their first visit with a physician after the seizure. The remaining 10 had relatively normal levels of consciousness and either were believed to have viral meningitis (2) or possessed straightforward indications for lumbar puncture: nuchal rigidity (6), prolonged focal seizure (1), or multiple seizures and a petechial rash (1). No cases of occult bacterial meningitis were found. Conclusion. In our review of 503 consecutive children with meningitis, none were noted to have bacterial meningitis manifesting solely as a simple seizure. We suspect that this previously described entity is either extremely rare or nonexistent. Commonly taught decision rules requiring lumbar puncture in children with fever and a seizure appear to be unnecessarily restrictive.

Original languageEnglish (US)
Pages (from-to)527-534
Number of pages8
JournalPediatrics
Volume92
Issue number4
StatePublished - Jan 1 1993

Fingerprint

Meningitis
Seizures
Fever
Bacterial Meningitides
Spinal Puncture
Febrile Seizures
Viral Meningitis
Muscle Rigidity
Coma
Exanthema
Consciousness
Signs and Symptoms
Referral and Consultation
Outcome Assessment (Health Care)
Physicians
Incidence

Keywords

  • febrile seizures
  • lumbar puncture
  • meningitis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Green, S. M., Rothrock, S. G., Clem, K. J., Zurcher, R. F., & Mellick, L. (1993). Can seizures be the sole manifestation of meningitis in febrile children? Pediatrics, 92(4), 527-534.

Can seizures be the sole manifestation of meningitis in febrile children? / Green, S. M.; Rothrock, S. G.; Clem, K. J.; Zurcher, R. F.; Mellick, L.

In: Pediatrics, Vol. 92, No. 4, 01.01.1993, p. 527-534.

Research output: Contribution to journalArticle

Green, SM, Rothrock, SG, Clem, KJ, Zurcher, RF & Mellick, L 1993, 'Can seizures be the sole manifestation of meningitis in febrile children?', Pediatrics, vol. 92, no. 4, pp. 527-534.
Green SM, Rothrock SG, Clem KJ, Zurcher RF, Mellick L. Can seizures be the sole manifestation of meningitis in febrile children? Pediatrics. 1993 Jan 1;92(4):527-534.
Green, S. M. ; Rothrock, S. G. ; Clem, K. J. ; Zurcher, R. F. ; Mellick, L. / Can seizures be the sole manifestation of meningitis in febrile children?. In: Pediatrics. 1993 ; Vol. 92, No. 4. pp. 527-534.
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