A 4-Year-Old Boy Is Brought to the Emergency Department by His

question 121

Multiple Choice

A 4-year-old boy is brought to the emergency department by his parents following a seizure.  The patient has had an upper respiratory illness for the last 2 days but has no previous history of seizures.  Today, he suddenly became unresponsive and his arms and legs started shaking for approximately 40 seconds.  The patient was alert when the paramedics arrived at his house.  In the emergency department, temperature is 40 C (104 F)  and pulse is 110/min.  The patient appears tired but is alert and cooperative.  Physical examination shows clear nasal discharge and mild pharyngeal erythema but no nuchal rigidity or other neurologic deficits.  Which of the following is the most likely underlying cause of this patient's seizure?

• A)Hyperthermia-induced diffuse neuronal dysfunction
• B)Microbial invasion of the meningeal layers
• C)Neuronal injury from cross-reacting antiviral antibodies
• D)Severe neuronal loss and gliosis in the hippocampus
• E)Synchronized discharge of thalamocortical tracts