9 years old male pt , came to paediatrics ER , stuper condition , no fever or vomiting or headach has bowel and urinery incontinence since 1 week has myoclonus since 3 months has auditory hallucination and loss memory since 3 months past history
I read the symptoms. The case has got complicated by trauma, convulsions,speech disorder and later ataxia. I would suggest doing blood gases study for now. Also know the pO2, pCO2 pH of blood. Bicarb level and base excess.Also, c reactive protein, ESR, mantoux, Also I would ask for a deeper history of hypoxia, anoxia, suffered any time during the seizure and brain injury.a decreased po2 at that time for 4 minutes is enough to damage the brain and keep the pupils reacting and dilated. A decreased serum sodium would suggest hyponatremia however subclinical gram negative infection must also be ruled out, esp tuberculosis and meningitis.(It's not always with a neck rigidity)