{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T03:28:30Z","timestamp":1781321310169,"version":"3.54.1"},"reference-count":5,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Arch Dis Child Educ Pract Ed"],"accepted":{"date-parts":[[2017,8,19]]},"published-print":{"date-parts":[[2018,12]]},"abstract":"A 5-year-old boy of non-consanguineous Indian descent presented to the emergency department (ED) following a prolonged seizure, preceded by a minor head injury from a low-level unwitnessed fall. The seizure was described as focal with head and neck version to the right. There was urinary and faecal incontinence and foaming at the mouth. The seizure lasted for 30\u2009min, following which the child made a rapid recovery and had no neurological deficit when examined in the ED. His initial observations were unremarkable, with him being afebrile, normotensive and having a blood sugar of 4.6\u2009mmol\/L.<\/jats:p>\n \n Question\u00a01<\/jats:title>\n Which imaging modality, if any, should be performed?<\/jats:p>\n <\/jats:sec>\n \n Question\u00a02<\/jats:title>\n Initial imaging showed two parenchymal lesions, one within the left frontal lobe and the other in the right parietal lobe with possible areas of blood or calcification. MRI (figure 1A,B) was urgently undertaken and reported as likely to be either haemorrhage into cavernomatous malformations, haemorrhagic metastases or haemorrhage within infected lesions such as tuberculomas.<\/jats:p>\n What would be the most useful next step in view of the differential diagnosis?\n \n CT chest and abdomen<\/jats:p>\n <\/jats:list-item>\n \n Perform a C-reactive protein<\/jats:p>\n <\/jats:list-item>\n \n Perform a Mantoux test<\/jats:p>\n <\/jats:list-item>\n \n Refer to neurosurgery<\/jats:p>\n <\/jats:list-item>\n \n Take a detailed family history<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Question\u00a03<\/jats:title>\n As the patient remained stable on the ward, with no signs of focal neurology and no mass effects on MRI, a lumbar puncture was performed the following day to exclude\u00a0tuberculosis (TB) (table 1). What cell appearance would indicate TB infection?<\/jats:p>\n <\/jats:sec>\n \n Question\u00a04<\/jats:title>\n A review of the mother\u2019s medical records and MRI scans revealed her to have multiple discrete cerebral cavernous malformations (CCMs) (figure 2).<\/jats:p>\n In view of this new information, what is the next step in investigating this child?<\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/archdischild-2017-313314","type":"journal-article","created":{"date-parts":[[2017,9,22]],"date-time":"2017-09-22T20:50:20Z","timestamp":1506113420000},"page":"302-303","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Post-traumatic seizure with an unexpected finding"],"prefix":"10.1136","volume":"103","author":[{"given":"Christine","family":"Brittain","sequence":"first","affiliation":[{"name":"Department of Paediatric Neurology, Child Development Centre, Addenbrooke\u2019s Hospital, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gautam","family":"Ambegaonkar","sequence":"additional","affiliation":[{"name":"Department of Paediatric Neurology, Child Development Centre, Addenbrooke\u2019s Hospital, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2017,9,22]]},"reference":[{"key":"2025090502170142000_103.6.302.1","unstructured":"NICE. Head injury: assessment and early management. 2014 https:\/\/www.nice.org.uk\/guidance\/cg176."},{"key":"2025090502170142000_103.6.302.2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1742-4658.2009.07535.x"},{"key":"2025090502170142000_103.6.302.3","doi-asserted-by":"publisher","DOI":"10.1038\/ejhg.2011.155"},{"key":"2025090502170142000_103.6.302.4","first-page":"116","article-title":"Central nervous system tuberculosis","volume":"11","author":"Cherian","year":"2011","journal-title":"Afr Health Sci"},{"key":"2025090502170142000_103.6.302.5","doi-asserted-by":"crossref","first-page":"45005","DOI":"10.18632\/oncotarget.6528","article-title":"Cerebral hemorrhage due to tuberculosis meningitis: a rare case report and literature review","volume":"6","author":"Zou","year":"2015","journal-title":"Oncotarget"}],"container-title":["Archives of disease in childhood - Education & practice edition"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/archdischild-2017-313314","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T09:17:13Z","timestamp":1757063833000},"score":1,"resource":{"primary":{"URL":"https:\/\/ep.bmj.com\/lookup\/doi\/10.1136\/archdischild-2017-313314"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,9,22]]},"references-count":5,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2018,11,20]]},"published-print":{"date-parts":[[2018,12]]}},"alternative-id":["10.1136\/archdischild-2017-313314"],"URL":"https:\/\/doi.org\/10.1136\/archdischild-2017-313314","relation":{},"ISSN":["1743-0585","1743-0593"],"issn-type":[{"value":"1743-0585","type":"print"},{"value":"1743-0593","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,9,22]]}}}