Convulsions

Introduction Convulsion is commonly known as cramping, convulsions, and convulsions, also known as convulsions. It is characterized by paroxysmal limbs and facial muscle twitching, often accompanied by upturned eyeballs, gaze or strabismus on both sides, unconscious. Sometimes accompanied by foaming at the mouth or mouth, apnea, complexion, and the attack time is more than 3 to 5 minutes, sometimes repeated, or even continuous. It is a common emergency in children, especially in infants and young children. The incidence of childhood convulsions under 6 years old is about 4% to 6%, which is 10 to 15 times higher than that of adults. The younger the age, the higher the incidence. Frequent seizures or persistent state of convulsions can endanger the life of the child or leave the child with serious sequelae that affect the child's mental development and health.

Cause

Infectivity

(1) intracranial infection: seen in meningitis, encephalitis, brain abscess, etc., with suppurative meningitis and viral encephalitis. Viral infection can cause viral encephalitis and Japanese encephalitis; bacterial infection can cause purulent meningitis, tuberculous meningitis, brain abscess, mold infection can cause new cryptococcal encephalitis, parasitic infections such as cerebral cysticercosis, brain Malaria, cerebral schistosomiasis, and brain paragonimiasis. Infant infection (TORCH infection) and cytomegalovirus infection in small infants can also cause convulsions.

(2) Extracranial infection: acute gastroenteritis, poisoning bacterial dysentery, sepsis, otitis media, tetanus, whooping cough, severe pneumonia and other acute serious infections, caused by high fever, acute toxic encephalopathy and brain microcirculation disorders Brain cell ischemia and tissue edema can cause convulsions. In the special period of pediatric brain development, it may have its special convulsion-heat convulsion due to fever. It is the most common type of convulsion in extracranial infection. It is caused by convulsions at 38 °C or above due to infections other than the central nervous system in children. Most of them occur in the upper respiratory tract infection or in the early stages of some infectious diseases.

2. Non-infectious

(1) intracranial diseases: common in craniocerebral injury (such as birth trauma, brain trauma), craniocerebral hypoxia (such as neonatal asphyxia, drowning), intracranial hemorrhage (such as late-onset vitamin K1 deficiency, cerebrovascular malformation) ()), intracranial space-occupying diseases (such as brain tumors, brain cysts), abnormal brain development (such as congenital hydrocephalus), cerebral palsy and neurocutaneous syndrome. There are also brain degenerative diseases (such as demyelin encephalopathy, cerebral macular degeneration) and other such as various encephalopathy (such as bilirubin encephalopathy), white matter degeneration.

(2) Extracranial disease

1 epilepsy syndrome: such as epileptic seizures, infantile spasms.

2 metabolic abnormalities: such as galactosemia, glycogenosis, hereditary fructose intolerance and other congenital glucose metabolism abnormalities, Niemann's disease, high snow disease, mucopolysaccharidosis, white matter dystrophy and other congenital fat metabolism Disorders, phenylketonuria, maple diabetes, histidineemia, ornithineemia and other congenital amino acid metabolism disorders, copper metabolism disorders such as hepatolenticular degeneration can also cause seizures.

3 Poisoning: Children often suffer from convulsions due to excessive consumption of poisons, drugs or drugs, direct effects of poisons or metabolic disorders caused by poisoning, and hypoxia. Common poisons are: carbon monoxide, organophosphorus pesticides, organochlorine pesticides, rodenticides, metals (lead, mercury, strontium), plants (toadstools, mandala, Xanthium), food (ginkgo, bitter almond) Etc. Common drugs are: atropine, camphor, chlorpromazine, isoniazid, steroids, aminophylline, and scorpion.

4 water and electrolyte disorders: such as severe dehydration, low blood calcium, low blood magnesium, low blood sodium, high blood sodium.

an examination

Related inspection

Electroencephalogram electroencephalogram

Selective laboratory and other ancillary examinations based on medical history, physical examination, and other clues.

1. Blood, urine, feces routine: white blood cells in the surrounding blood picture increased significantly, the percentage of neutrophils increased often prompted bacterial infection, the original naive cells increased, pay attention to the possibility of meningeal leukemia, suspected enteritis, bacillary dysentery, sent stool Inspection and culture (if necessary, cold saline enema to collect fecal specimens), suspected urinary tract disease, urine test and urine culture if necessary.

2. Blood and urine special examination: When suspected phenylketonuria, it can be tested for urinary ferric chloride or the blood phenylalanine content.

3. Blood biochemical examination: When hypoglycemia, hypocalcemia, hypomagnesemia or other electrolyte disorders are suspected, blood glucose, blood calcium, blood magnesium, blood sodium, urea nitrogen and creatinine should be selected.

4. Cerebrospinal fluid examination: suspected intracranial infection can be routine, biochemical, if necessary, smear staining and culture.

5. ECG and EEG examination: suspected cardiogenic convulsions can choose to do ECG. Suspected infantile spasms and other types of epilepsy or brain occupying lesions can be used for EEG, which is helpful for diagnosis.

6. Other examinations: suspected intracranial hemorrhage, space-occupying lesions and craniocerebral malformations, optional for air-brain screening, cerebral angiography, skull CT and other examinations.

Differential diagnosis

(1) Febrile seizures: When the acute infectious diseases such as upper respiratory tract infection, acute tonsillitis, pneumonia and infectious diseases are high fever, the central excitability is increased, and the nerve dysfunction causes convulsions, which is called febrile seizures. The incidence is very high. According to the survey, 5-8% of children have had febrile seizures, accounting for 30% of the causes of childhood seizures. Its characteristics are:

1 The age of good hair is from June to 3 years old. After 3 years of age, the frequency of attacks is reduced. It is rare to occur below 6 months and above 6 years old.

2 The upper sense is 60%, often occurs when the body temperature rises sharply at the beginning of the disease, and the body temperature often reaches 39 to 40 °C. The higher the body temperature, the more chances of convulsions.

3 systemic convulsions accompanied by disturbances of consciousness, but after the shock, consciousness quickly recovered.

4 In a febrile illness, usually only one episode, rarely more than two episodes.

5 convulsion time is short, several seconds to several minutes, generally no more than 5-10 minutes.

6 The neurological examination was negative, and the cerebrospinal fluid examination showed no increase in pressure except for the increase in pressure.

7 EEG examination was normal after 1-2 weeks of onset.

(two) intracranial infection

It can be invaded by the central nervous system by bacteria, viruses, molds, etc., causing damage to the meninges and brain parenchyma and cerebral edema. Epidemic cerebrospinal meningitis is common in winter and spring. Japanese encephalitis is more common in summer and autumn, while viral (sporadic) encephalitis and tuberculous meningitis are scattered all year round. Brain abscess usually has otitis media, sepsis and cyanotic congenital heart disease. Precursor disease. Children with intracranial infection have fever, headache, vomiting, lethargy, convulsions and coma, often with meningeal irritation and pyramidal pathology. Cerebrospinal fluid examination has diagnostic value for epidemic cerebrospinal meningitis, Japanese encephalitis, viral (sporadic) encephalitis, tuberculous meningitis, and cryptococcal meningitis. Brain abscesses often have symptoms and signs of acute infection, intracranial hypertension and localization signs, for head CT examination can be clearly diagnosed, and the location and size can be determined.

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