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Hypoglycaemia — MCCQE Part 1 MCQ

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HardAltered Level of ConsciousnessHypoglycaemiaMCCQE Part 1

A 12-year-old was treated promptly for convulsive status epilepticus. Motor activity stopped 25 minutes ago, but the child remains unexpectedly unresponsive with intermittent eyelid twitching. Airway, ventilation, circulation, glucose, temperature, and electrolytes are stable. What is the most appropriate next investigation?

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Correct answer: B — Obtain urgent electroencephalography to assess for nonconvulsive status epilepticus

Persistent depressed consciousness after visible convulsions have stopped may represent nonconvulsive status epilepticus rather than an uncomplicated postictal period. The intermittent eyelid twitching heightens concern, but nonconvulsive seizures may have no obvious motor correlate. Canadian Paediatric Society guidance recommends EEG when consciousness does not recover as expected after convulsive status epilepticus. Airway and physiologic stabilization and the search for reversible causes continue in parallel. If urgent EEG cannot be obtained, neurology consultation and empiric treatment for nonconvulsive status are appropriate. Lumbar puncture may be indicated when infection is suspected, but it should not precede evaluation and treatment of possible ongoing seizure activity in this stabilized scenario.

Reference: Canadian Paediatric Society, Emergency management of the paediatric patient with convulsive status epilepticus, https://cps.ca/en/documents/position/emergency-management-of-the-paediatric-patient-with-convulsive-status-epilepticus