What is the focus of the physical exam for evaluation of pediatric first seizure?

Updated: Aug 16, 2018
  • Author: Shelley R Waite, MD; Chief Editor: Amy Kao, MD  more...
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A thorough general examination and detailed neurologic examination should be performed. In particular, the patient should be evaluated for the following:

  • Fever or other abnormalities in vital signs

  • Signs suggestive of trauma or the presence of an intracranial shunt

  • Dysmorphic features and abnormal neurodevelopment

  • Papilledema, suggesting increased intracranial pressure

  • Nuchal rigidity or other signs of meningismus (specific signs of meningitis may be absent in children, particularly in neonates and infants younger than 6 mo)

  • Skin features such as port-wine stain, facial angiofibromas, hypopigmented macules, or shagreen patch suggestive of neurocutaneous syndrome, or petechial rash suggestive of meningococcal infection

  • Focal neurologic deficits, which may be indicative of an underlying focal structural lesion or postictal Todd paresis

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