Febrile seizure with persistent altered consciousness - red flags
HIGH-YIELD
Appears 3×
Teaching point — how the wording changes the answer
Persistent drowsiness/depressed consciousness after a febrile seizure is a red flag for meningitis/encephalitis and means it is NOT a simple febrile seizure - exclude CNS infection (LP if no contraindication, blood cultures, monitoring). Prolonged/afebrile-onset seizures with altered conscious state or focal signs require urgent CT brain.
Q27
2-year-old with infection, febrile convulsion given midazolam but remains very drowsy and lethargic; next step?
Key clue
Persistent depressed consciousness post-seizure = exclude CNS infection
Show answer
Lumbar puncture (with blood culture and close monitoring)
Q83
4-year-old with afebrile fits, drowsy and unresponsive, brisk reflexes; investigation?
Key clue
Prolonged altered conscious state + hyperreflexia after afebrile seizure
Show answer
CT brain (urgent neuroimaging)
Q81
Child with a seizure who becomes floppy; likely diagnosis?
Key clue
Abrupt loss of muscle tone
Show answer
Atonic seizure (drop attack)