Fever, Seizures, and Basal Ganglia Lesions

Abstract

We describe the case of a previously healthy 17-year-old boy admitted to the hospital after a generalized tonicclonic seizure that followed a 3-day history of fever, malaise, and headache.At presentation, he was in no distress with a heart rate of 75 beats per minute, respiratory rate of 14 breaths per minute, temperature of 36.5 °C, oxygen saturation on room air at 99%, and blood pressure of 127/ 82 mm Hg. His Glasgow Coma Score (GCS) was 13, with disorientation to time and place. His receptive language was intact. However, he had difficulty finding words and responded with one-word answers. He had both long and short-term memory loss but no focal neurological signs. Pupils were equal and reactive to light, with normal range of eye movement and no nystagmus. Fundoscopy was normal. There was no facial asymmetry or tongue fasciculations. He had normal tone, muscle bulk, power 5/5, and reflexes 2+ in the upper and lower limbs. Sensation, gait, and coordination were intact. There were no abnormal movements or meningeal signs. Brudzinski and Kernig signs were not elicited. A complete cardiorespiratory and gastrointestinal exam was unremarkable. There was no rash, joint tenderness or swelling.Investigations at presentation showed high white blood cell count of 11.8 × 10 9 / L, neutrophils at 7.7 × 10 9 / L, lymphocytes at 2.9 × 10 9 / L, hemoglobin of 146 g/L, and platelet of 194 × 10 9 / L. Cerebrospinal fluid (CSF) cell count was elevated at 54 × 10 6 /L, protein was high at 0.64 g/L, and glucose was 2.8 mmol/L. Repeat labs revealed mild anemia on day 4 of admission (lowest hemoglobin 134 g/L, hematocrit 0.385), which resolved without interventions by day 10 of admission.