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Febrile seizure in an adult mimic — SCE Neurology MCQ

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EasyEpilepsyFebrile seizure in an adult mimicSCE Neurology

A 42-year-old woman presented with a collapse with jerking during a rigors episode from pyelonephritis. On examination, she had rapid orientation after the event and no lateral tongue injury. Initial investigations showed: blood cultures were positive; EEG and MRI were normal after recovery. What is the most appropriate management?

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Correct answer: E — Start or optimise antiseizure therapy after specialist assessment

Start or optimise antiseizure therapy after specialist assessment is the best answer because the vignette describes Febrile seizure in an adult mimic: rigors can mimic convulsive seizure when consciousness is not clearly impaired. Urgent reperfusion assessment with thrombolysis or thrombectomy pathway is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. High-dose glucocorticoids with urgent visual protection and Multidisciplinary rehabilitation with goal-setting are less appropriate because they would require different localisation, timing or test findings; Empirical intravenous ceftriaxone after blood cultures would fit a different syndrome. Clinical pearl: true seizures should cause postictal symptoms or objective epileptic features.

Reference: NICE NG217; BNF; DVLA Assessing fitness to drive