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American Academy of Pediatrics
Article

Can Seizures Be the Sole Manifestation of Meningitis in Febrile Children?

Steven M. Green, Steven G. Rothrock, Kathleen J. Clem, Raymond F. Zurcher and Laura Mellick
Pediatrics October 1993, 92 (4) 527-534;
Steven M. Green
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Steven G. Rothrock
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Kathleen J. Clem
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Raymond F. Zurcher
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Laura Mellick
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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.

  • lumbar puncture
  • meningitis
  • febrile seizures
  • Received February 5, 1993.
  • Accepted April 22, 1993.
  • Copyright © 1993 by the American Academy of Pediatrics

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Pediatrics
Vol. 92, Issue 4
1 Oct 1993
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Can Seizures Be the Sole Manifestation of Meningitis in Febrile Children?
Steven M. Green, Steven G. Rothrock, Kathleen J. Clem, Raymond F. Zurcher, Laura Mellick
Pediatrics Oct 1993, 92 (4) 527-534;

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Can Seizures Be the Sole Manifestation of Meningitis in Febrile Children?
Steven M. Green, Steven G. Rothrock, Kathleen J. Clem, Raymond F. Zurcher, Laura Mellick
Pediatrics Oct 1993, 92 (4) 527-534;
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Cited By...

  • Nothing Is Simple About a Complex Febrile Seizure: Looking Beyond Fever as a Cause for Seizures in Children
  • Febrile Seizures: Guideline for the Neurodiagnostic Evaluation of the Child With a Simple Febrile Seizure
  • To Tap or Not: Bacterial Meningitis & Complex Febrile Seizures
  • Yield of Lumbar Puncture Among Children Who Present With Their First Complex Febrile Seizure
  • Utility of Lumbar Puncture for First Simple Febrile Seizure Among Children 6 to 18 Months of Age
  • Parental Attitude to Lumbar Puncture for Children With Fever and Seizure: In Reply
  • Pneumococcal Meningitis Presenting With a Simple Febrile Seizure and Negative Blood-Culture Result
  • Meningitis is a common cause of convulsive status epilepticus with fever
  • Febrile seizures: an update
  • An evidence and consensus based guideline for the management of a child after a seizure
  • Lumbar puncture following febrile convulsion
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