A young child presents with a first seizure. He has no past medical history of note. In the morning he was a bit lethargic but otherwise had no specific symptoms. On arrival he is febrile (39degC) and post-ictal. (tick all that are true)
Partial, multiple or prolonged (over 30 mins) seizures make the diagnosis of febrile convulsion less likely Classic meningism may not be detected in infants with meningitis
Bacterial meningitis can present with fever and seizures, but the prevalence of meningitis is falling with the introduction of Hib, MenC and Pneumococcal vaccines. In the typical patient with febrile convulsion, you would have to do over 200 LPs to detect one case of meningitis. Seizures have been reported to increase protein counts (up to 0.5) and neutrophil %(up to 55%), but not total white cell count so probably not clinically significant.