Convulsive syncope

Hi- I am the mother of an 11 year old boy who experienced a seizure after me examining his ear with an otoscope. HE was complaining of an earache the night prior which we treated with tylenol then Ibuprofen. That morning I wanted to examine to see if he in fact had an infection or just fluid in his ear. He had tubes in back when he was 6 and then they removed them a few years later. Immediately after me taking the otoscope out he lost his vision, arching his neck and a few grunting sounds , lost control of his urine and I lowered him to the floor where he was dazed but not totally out. I would say start to finish maybe 30 seconds. A Little clamy and sweaty, little nauseated ( no vomitting) and we did end up taking him to the E.R.. The doctor did not run 1 test except put him on antibiotics and told us to give him Benadryl to help dry up the fluid. And follow up with his primary and ENT doctor. Exactly 3 years ago he did have an episode that was similar as far as fainting and losing his urine while he was fighting a family virus that was going around. The E.R. doctor told me that I probably triggered his vasal vagus nerve? Yes ?No?Maybe? He seemed to do much better when lying down. What kind of tests do you think I should be asking for? He sees the ENT tomorrow.  Thanks

[pcsmom]

I would recommend your child see a neurologist.  With the symptoms you described, it definitely sounds like a seizure of some sort.  When my daughter was 11 months old she started having seizures where her eyes would roll back in her head, she would arch her back, fists clenched, and her lips would turn blue.  I brought her to a pediatric neurologist and she was diagnosed with a seizure disorder.  Luckily she outgrew her condition by age 4 1/2 as the neurologist predicted.  The neurologist recommended that when she experienced a seizure, I should lay her down on her left side.  He said that this helps the body regulate itself, returning blood flow and pressure back to normal.

[Dennis MD]

Hi.
I understand what you've been going through.
Do the seizure episodes only happen after inserting an otoscope?
Is your child's eardrum perforated?
Ear infection, especially in the setting of a perforated eardrum, can result in ascending infection to the brain, and can result in meningitis.  Meningitis usually presents with fever, neck rigidity, eye changes, seizures.  Patients with meningitis also look ill, sometimes with changes in sensorium.
I agree with your decision to bring your child to an ENT specialist for proper evaluation and management.  I would also suggest to bring him to a pediatric neurologist especially if the ENT findings are unremarkable.
Good luck.
  

[nlemorta]

Saw the ENT today. He said that he most likely did not experience the seizure like fainting experience from the otoscope being inserted into his ear. He said he saw a little fluid and that his infection is cleared up. Wants to see us in 3 weeks.  I definitely feel that he is more prone to having these episodes when he is ill with his electorolytes being off. Low blood pressure. I would most describe his scenario as being a convulsive syncope. I am going to foolow up with his primary matbe getting an EEg and an EKG to make sure we don't have a heart issue. I guess it's important to say that whereever he goes the company that he is in has to be aware of his condition.Including never swimming alone forever!!! Our daughter  (3yrs old) had 2 fainiting spells with convulsions which they related to BHS. breath holding syndrome when she got upset. An EEG showed normal results. My husband also had some seizure like events when he was about his age and never had them again. As well we have a nephew with a few fainting spells. It's just a little unnerving when you don't have the right answer. Lots of gatorde to drink and giving him salty things to eat daily. Thanks for your input.

[Kamal S Saini, MD, MRCP (UK), DM]

Hello. Since you have described two distinct episodes of what looks like a seizure, you must consult a Paediatric Neurologist. The first test you must ask for is the Electro-encephalogram (EEG) to rule out any possibility of epilepsy. Any other test will be secondary, as EEG will decide the course of the treatment. EEG will also show us if there is currently any seizure like activity going on in the brain. And if the test results are normal, you can relax. There is a possibility of the seizure being secondary to the viral infection of the nervous system. You also need to check if the
ear drum is perforated (in view of the ear discharge). Your ENT surgeon will be able to tell you. In the case where it is found out that the infection of the nervous system is secondary to ear infection (upward spread), functional MRI or a CT scan can give a clear picture of the extent of brain involved, if at all. Lying down, the blood pressure reduces a bit and helps ease the condition. I would like to know more about the tubes in back, though.

[artms]

I am now 55. When I was nine I had a seizure. They diagnosed me as having encephalitis with epileptic seizures. I was placed on medications which left me extremely lethargic throughout my school years. I also suffered the stigma attached to epilepsy at that time. To this day I  only 'pass out' when I vomit. To make a long story short, I gathered all my pediatric records and saw a neuologist when I was 32. He told me I had been misdiagnosed as a child. What I indeed have is vasovagel synchopy. My children have this as well.