Seizures in a Non-Communicative Child: Summary

Physical Examination

The patient's temperature was 36.9 oC (98.4 oF), his respiratory rate was 26 breaths per minute, his pulse was 100 beats per minute, and his blood pressure was 128/86 mm Hg. On examination, he appeared well nourished and in no acute distress. His neck was supple with no lymphadenopathy. He became irritated with anyone in close proximity of his head, mouth, and ears and had poor eye contact, which is consistent with children who have autism. An eye examination was done under papoose restraint. His pupils were equal and reactive to light, with his extraocular muscles intact. He had sharp disc margins. His tongue was midline. His lungs were clear upon auscultation, and an examination of the cardiovascular system revealed no murmurs, rubs, or gallops and a regular heart rate and rhythm. Decreased tone was noted in his upper extremities, and he was sensitive to touch with monofilament fiber on examination. Tip-toe walking was noted, which is frequently seen in children with autism and is part of his normal behavior. He had negative Gower's and Romberg's signs. Gower's sign indicates proximal muscle weakness and describes patients who use their hands to "walk" up the body from a squatting position. Gower's sign is seen in persons with muscular dystrophy, paraplegia, and conditions with proximal muscle weakness or atrophy. Romberg's test indicates sensory ataxia and is performed by having patients stand with their feet together and their eyes closed while the examiner observes for swaying or unsteady gait with the eyes closed. His gait was awkward and had not changed since the previous examination. Deep tendon reflexes were 2+ in all extremities. Cranial nerves I-XII were grossly intact