Decerebrate posturing

cointosser13

Forum Crew Member
Messages
63
Reaction score
4
Points
8
I want your input guys....

We ran a call that was called out for a seizure. In the notes it said patient vomited x1. We get inside and mother is right next to her 6 year old kid who's not moving and looks wet. We asked what happened, mother said something along the lines of "my kid was in the bathtub when he had a seizure, and he went under for a few seconds". We immediately put the kid in the ambulance. We responded, and did the usual, vitals, put in a IV. The kid was only responsive to pain. In our protocols we're not supposed to give benzos unless the kid is really seizing. Anyway, as we're responding, the kid starts to posture. First time seeing it but I looked at the whole presentation of the patient. Legs were extended, arms extended with wrists rotated. Kid was moaning when this was occurring. Checked the jaw, and it was completely clenched. Pupils,they were originally constricted, when we got to the hospital they were more dilated. No previous trauma, no medical history other than prior seizure 2 years ago. Couldn't get any more information from the mom. Kid SpO2 was around 98% on NRB, blood pressure was 124/72, and respirations were around 18 and regular. It all didn't make any sense. When we got to the hospital we found out that patient had autism, and was NOT up to date with shots. What are you thoughts guys? Really this is all the information I have because the scene was a little chaotic.

At the hospital they ended up doing an LP to check for meningitis. I don't know the result of the test yet.
 
Unfortunately without additional information it would be hard to narrow it down. Things like what type of neuro exam did the patient have, any fever, recent illness or sick contacts at home, travel? With a previous seizure history was the patient on daily meds, or was that something like an isolated febrile seizure? What was the patient's blood glucose? Did the patient have signs of pulmonary edema from the submersion?

Could be a tonic seizure, infection, cerebral hypoxia, pontine stroke, the list could go on and on..... More information on the HPI would be helpful.
 
Any thing that can cause increased ICP can cause posturing.

If no brain bleed/head trauma/tumor is suspected, you have to start considering the other rare causes of seizures and posturing. (Keep in mind that "posturing" during a seizure, but not afterwards, can be normal during a seizure.)

One thing that comes to mind for me (other then meningitis) is Reye's syndrome.

Also, keep the BP in mind. A normal BP for a 6 year old is around 95/60.
 
Back
Top