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SECTION V
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PEDIATRIC NEUROLOGICAL EMERGENCIES
By
Anthony Briningstool, Sparrow/MSU Emergency Medicine Residency Program Lansing, Michigan,
Jane Turner, Michigan State University East Lansing, Michigan
The presenting symptoms of CNS infections in children 2-24 months of age typically are nonspecific. Fever, seizures, poor feeding, and irritability are the most common symptoms. Patients with viral meningitis can also present with fever, headache, and stiff neck. In contrast to children with bacterial meningitis, children with viral CNS infection rarely appear toxic. CSF results usually confirm the diagnosis. Clinical stabilization is followed by administration of antibiotics and occasionally corticosteroids when bacterial meningitis is suspected. The use of Dexamethasone has been found to improve the outcome from bacterial meningitis in children in some studies. Neurological sequelae, specifically hearing impairment, occurred less often in children who received Dexamethasone early on. Children currently taking antibiotics at the time of presentation to the emergency department pose a unique challenge. Children with partially treated meningitis present differently and are more likely to have a history of vomiting with prolonged symptoms.
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