A Previously Healthy Adolescent With Acute Encephalopathy and Decorticate Posturing

Area of Science:

• Pediatric Neurology
• Neurocritical Care
• Adolescent Medicine

Background:

• A 14-year-old female presented with unresponsiveness, fever, and pharyngitis.
• Initial workup revealed no history of substance use, toxic ingestion, or mental health concerns.

Observation:

• The patient required intubation due to a low Glasgow Coma Scale score (3).
• Neurological examination showed dilated pupils, decorticate posturing, and lower extremity rigidity and clonus (Glasgow Coma Scale 5).
• Initial laboratory and imaging studies, including head CT, were unremarkable.

Findings:

• The patient experienced a seizure, treated with diazepam and fosphenytoin.
• Cerebrospinal fluid analysis was pending, with empiric antibiotics initiated for suspected meningitis.
• Further evaluation included electroencephalogram (EEG) monitoring and advanced neuroimaging (CTA, MRA/MRV).

Implications:

• This case underscores the importance of a comprehensive diagnostic approach in adolescent acute encephalopathy.
• Prompt recognition and management of neurological emergencies are critical for patient outcomes.
• Further investigation is needed to determine the etiology of the patient's severe neurological presentation.