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Hooshang Semnani, MD, FAAP; Alfeo V. Reminajes, MD; Zahra Tavakoli, MS
From the Northridge Hospital Medical Center Pediatric Intensive Care Unit, Northridge, Calif.

Arch Pediatr Adolesc Med. 2000;154:1269-1270.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

A 4-YEAR-OLD boy was lethargic and grinding his teeth. He had an upper respiratory tract infection 2 weeks earlier. His medical history was unremarkable. On physical examination, his temperature was 36.6°C; heart rate, 120 beats per minute; respiratory rate, 18 beats per minute; and blood pressure, 94/59 mm Hg. Findings from neurological examination showed his pupils dilated but equally reactive (6-4 mm). He was irritable and lethargic with normal findings from sensory examination and deep tendon reflexes. Results of a lumber puncture included clear colorless fluid under normal pressure with no red blood cell count; total white blood cell count, 10.0 x 10⁹/L (10% neutrophils, 90% lymphocytes) (manual differential on white blood cell count in cerebrospinal fluid); glucose concentration, 3.8 mmol/L (68 mg/dL); protein level, 290 mg/L, and negative findings from Gram stain. Magnetic resonance imaging showed multiple . . . [Full Text of this Article]