A mysterious case of seizures in the ER

Alex and Edward Santos have just returned from a weekend away at their aunt and uncle’s place. They love it there. The couple is in their 20s and spoil the boys with late bedtimes, movies and video games, and home-made cupcakes with chocolate icing and sprinkles. It’s been a long break for Alex, who’s 15, and has been off school for a week. Now, his vacation is almost over, he eats quickly so he can get to his part-time job on time. While his mother is busy preparing for the week ahead, 11-year-old Edward sneaks off to the basement for a little time with the PS4. With his older brother away at work, he can play whatever he wants, and can even get online, and go head-to-head against his friends.

At first, the gaming is great — “the best ever,” he’d later say, but after an hour, he drops the controller and lumbers up the stairs.

“Mom,” he said. “I don’t feel well.”

His mother puts a hand on his forehead. No fever. “Do you want to go upstairs and lie down?”

“OK.”

“Why don’t you get into your pajamas and brush your teeth. I’ll be up there in 10 minutes.”

Minutes later, however, she hears screams from the bedroom. “Help me! Please! Help me!”

Both she and her husband sprint upstairs. Edward’s skin is pale and he’s clutching his chest. “It hurts! It hurts so bad! Please! Help me! I need to go to the hospital! Take me to the hospital!” His heart is beating so fast that his mother can see it bounding through the slight boy’s T-shirt.

Panicked, they ask him everything that comes to mind as they rush him downstairs, help him with his shoes and jacket, and race toward the hospital. Do you feel warm? Do you feel like you’re going to throw up? Do you have to go to the bathroom? Were you coughing? Do you have a cough? Can you breathe? Did you eat anything? Drink anything? Does your stomach hurt? Did you hurt yourself? Is it an allergic reaction? Were you playing with the cat?

Half-way to the hospital, the young boy is still clutching his chest and panting, his skin so white, it looks like the blood has been drained from his body. And now, everything is starting to hurt – his head, his arms, his stomach, his legs. At the triage desk, Edward slumps into a chair, and suddenly becomes limp. Although he’s breathing, his eyes are vacant, and when the nurse asks him a question, he doesn’t answer.

His vital signs are normal — no fever, heart rate regular at eighty beats per minute, blood pressure 100/60. Although his oxygen saturation is almost 100 percent and his breaths are slow and even, he looks awful — withdrawn, ghost-like, and unsteady on his feet. He’s moved to a wheelchair, and whisked into the department.

It’s 9 p.m. I’m sitting with a man in his 20s whose head is wrapped in gauze. He tripped, he tells me. He was lifting something off the floor when he tripped — either over his own feet, or on something else.

I unravel the gauze. “But the cut is at the back of your head.” I put a gloved hand into the wound. “And this gash is huge.” I come around to face him. “And your forehead is bruised too.”

“I might have fallen backward.”

“Did you faint?”

“Probably,” he says. “I didn’t eat lunch or dinner.”

I flip through the chart. He was brought by ambulance. His girlfriend found him on the floor. Confused. Bleeding. “You didn’t drink or take any drugs?”

“Nope.”

“You felt fine all day?”

“Yup.”

“How do you feel now?”

“Perfect,” he says. I study his ECG. It’s normal.

“OK,” I say. “I’ll get what I need to stitch this.”

I leave the room and I notice a boy slumped in a wheelchair. He looks terrible. “Who is that kid?”

I ask my assistant. “He looks super-sick. Has he been seen yet?”

“No idea,” he says.

“Well find out.”

He points to the computer screen. “Here’s the board, only four waiting to be seen.”

I scan the list. There’s nobody that fits his description — no kids between eight and 16. He must have been seen by a doctor already.

One of my colleagues comes out of an exam room. I ask him about the patient. He tells me what he knows — previously healthy, sudden onset of pain, pallor, weakness. Nothing else. He was at home with his parents playing video games when he became unwell.

He’d come in with both parents, but his father had left to pick up his older brother from work.

I return to the suture room and chat with the young man while I stitch his head. I ask if he has any medical problems, or if he’s ever had surgery. He says no. I ask if he takes medications. He doesn’t. I ask again if he smokes, drinks or uses drugs. He doesn’t. I ask what he does for work, and if he plays sports. He’s a bartender and he plays ultimate in the summer. It takes nine stitches to close the wound. “Any family history of sudden cardiac death?” I ask.

“No.”

“Seizures?”

“No family history,” he says slowly, “but actually I was on seizure medication until I was 16, and then my parents took me off them.”

“Why?”

“I don’t know. I guess I had seizures when I was little.”

“That’s it,” I say. “You had a seizure. And when your girlfriend found you, you were postictal.”

An hour later, I ask my colleague about his patient. “Still no answer,” he says. “Blood work is back — it’s normal — so is his chest X-ray.”

“Is he OK?”

“He’s coming around a little,” he says.

Two hours later, my colleague is called by a nurse. The final test — Edward’s urine toxicology — is back. By now, his older brother is there. His father was going to take him home, but Alex wanted to see his little brother. And when he did, he turned to his mother and said, “he looks like he’s dying.”

Results in his hand, the doctor has a chat with the parents, and then, Edward’s mother takes the older brother to a quiet corner to talk to him.

“Alex,” she says. “I need to ask you something, and I need the truth. No matter what you tell me, you won’t be in trouble. We can talk about it later, but I need you to tell me the truth.”

“OK,” the older brother says.

“Do you have any cannabis edibles in the house.”

“Yes.”

A week before, a friend had offered him brownies. Special brownies. He’d been offered them before — along with joints — over the past year. He was curious, so he took them, but wasn’t sure if he wanted to try them. Instead, he kept them in his school bag, which was in the basement, just steps away from the PS4. And when Edward found them, he later explained, he thought his aunt had made them, and that his brother was hoarding them. “I would have eaten them all,” he said. “If I didn’t get full after one and a half.”

After a day of rest, Edward is back to normal. And Alex is no longer curious about trying the brownies. His brother helped him figure out that they probably weren’t worth it.

Raj Waghmare is an emergency physician who blogs at ERTales.com.

Image credit: Shutterstock.com

Leave a Comment

Most Popular

Join 150,000+ subscribers

Get the best of KevinMD in your inbox

Sign me up! It's free. 
close-link
✓ Join 150,000+ subscribers 
✓ Get KevinMD's 5 most popular stories
Subscribe. It's free.