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| An 18-month-old male is brought to the ED for evaluation of a brief episode of tonic-clonic extremity movements immediately after being spanked at the grocery store. The child reportedly screamed, became limp and pale, fell to the ground, and exhibited the unusual movements. The episode lasted about 1 min and occurred about 30 minutes ago. The toddler is now interactive, appears healthy, and has normal vital signs. What is the MOST likely diagnosis | ||
A. Breath-holding spell |
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B. Head trauma |
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C. Toxic ingestion |
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D. Prolonged QT syndrome |
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E. Idiopathic (afebrile) seizure of childhood |
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Explanation: A "breath-holding spell" typically occurs after an abrupt trauma (fall, spanking) or a verbal reprimand. It is typified by a sudden cry, followed by prolonged inhalation or exhalation (resulting in no air exchange), and a Valsalva maneuver with vagotonic effects (bradycardia). A brief tonic seizure, not considered to be epileptic, occurs. Head trauma in this child would be an unlikely cause of seizure because the child is neurologically normal. Toxic ingestion is always a consideration in this age of greater mobility, curiosity, and dexterity. However, some aberration in mental status or vital signs wouldd be expected with ingestion severe enough to cause a seizure. Congenital heart disease can produce paroxymsmal events at all ages. Pulmonary hypertension, tetralogy of Fallot, acquired cardiomyoopathies, and prolonged QT syndrome should be considered. Idiopathic seizures account for up to 47 percent of afebrile seizures in children. (Source: Emergency Medicine PreTest) |
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