Can seizures be the sole manifestation of meningitis in febrile children?

Pediatrics. 1993 Oct;92(4):527-34.

Abstract

Objective: It is frequently taught that lumbar puncture is a mandatory procedure in many or all children who have fever and a seizure, because the convulsion may represent the sole manifestation of bacterial meningitis. We attempted to determine the incidence of this occult manifestation of meningitis.

Design: Retrospective case series.

Setting and patients: 503 consecutive cases of meningitis in children aged 2 months to 15 years seen at two referral hospitals during a 20-year period.

Main outcome measures: Signs and symptoms of meningitis in patients having associated seizures.

Results: Meningitis was associated with seizures in 115 cases (23%), and 105 of these children were either obtunded or comatose at their first visit with a physician after the seizure. The remaining 10 had relatively normal levels of consciousness and either were believed to have viral meningitis (2) or possessed straightforward indications for lumbar puncture: nuchal rigidity (6), prolonged focal seizure (1), or multiple seizures and a petechial rash (1). No cases of occult bacterial meningitis were found.

Conclusion: In our review of 503 consecutive children with meningitis, none were noted to have bacterial meningitis manifesting solely as a simple seizure. We suspect that this previously described entity is either extremely rare or nonexistent. Commonly taught decision rules requiring lumbar puncture in children with fever and a seizure appear to be unnecessarily restrictive.

Publication types

  • Case Reports
  • Multicenter Study

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Coma / epidemiology
  • Coma / etiology
  • Female
  • Humans
  • Infant
  • Male
  • Meningitis, Bacterial / complications*
  • Meningitis, Bacterial / epidemiology
  • Retrospective Studies
  • Seizures / epidemiology
  • Seizures / etiology*
  • Spinal Puncture
  • Time Factors