Pediatric emergency medicine trisk 1428 1428
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Hyponatremia
Hypoxia
Inborn errors of metabolism
Pyridoxine
deficiency
Uremia
Vascular
Cerebrovascular accident
Hypertensive encephalopathy
Oncologic
Primary brain tumor
Metastatic disease
Endocrine
Addison disease
Hyper/hypothyroidism
Obstetric
Eclampsia
Traumatic
Cerebral contusion
Diffuse axonal injury
Intracranial hemorrhage
Congenital anomalies
a Bold
type denotes most common causes. Given their nature, virtually all these etiologies are potentially
life-threatening, except perhaps febrile seizures. Febrile seizures and breakthrough seizures of patients with
known epilepsy (whether compliant with their medication or not) represent the majority of seizure episodes
encountered in an emergency department setting.
DIFFERENTIAL DIAGNOSIS
There are many different types of events that mimic seizure activity.
Syncope, or the transient loss of consciousness that results from inadequate
cerebral perfusion or substrate delivery, is the most common alternative diagnosis
given to patients who present for the evaluation of a seizure episode (see Chapter
76 Syncope ). Further complicating matters is the fact that a small percentage of
patients with syncope exhibit some sort of convulsive movement. Although
vasovagal episodes or orthostatic hypotension is the most common cause for
syncope, it is important to evaluate these patients for potential underlying cardiac
disease.
