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PE27.1-14 | Central Nervous System — Assignment

CLINICAL SCENARIO

You will select ONE of the two provided clinical scenarios (Case A: an infant with suspected meningitis; Case B: a child with first seizure episode) and produce a structured clinical analysis that integrates your knowledge of paediatric CNS disorders. This writeup mirrors the real-world process of evaluating and managing an acutely unwell child with a neurological problem — a core skill for any clinician working in paediatric or general settings in India.

Instructions

Read both cases below and select ONE to analyse in depth.

Case A — Meningitis: A 15-month-old boy is admitted with 3 days of fever (38.9°C), refusal of feeds, two vomiting episodes, and increasing drowsiness. On examination: GCS 12/15, neck stiffness positive, Kernig's sign positive, no rash, no papilloedema. His NIS immunisation is up to date including pentavalent and PCV.

Case B — First Seizure: A 7-year-old girl is brought after a witnessed episode of staring (30–40 seconds), with lip-smacking, unresponsiveness, and mild confusion lasting 2 minutes. There was no jerking, no tongue bite, no incontinence. She had a similar episode 3 weeks ago. She is otherwise healthy, EEG shows right temporal theta slowing.

For your chosen case, complete each section below using the scaffolding headings.
All drug doses must be stated in mg/kg (not adult fixed doses). Use IAP/NMC 2024 guidelines and Ghai Essential Pediatrics as your primary references.
Word count: 900–1200 words (excluding the CSF/investigation table if included).
Submit as a structured document with clear headings matching the sections below.

Length: 900–1200 words (excluding investigation comparison tables)

What to Submit

1. Problem Identification and Differential Diagnosis

Guidance: State the working diagnosis and list 3-4 differential diagnoses in order of probability. For Case A: distinguish bacterial vs viral vs tuberculous meningitis using the history and examination findings. For Case B: classify the seizure type (focal? generalised? absence?) using ILAE criteria and list differentials including focal epilepsy, absence epilepsy, and non-epileptic events. Justify each differential with one or two clinical features from the case.

2. Targeted Investigation Plan with Interpretation

Guidance: List the key investigations you would order AND what you expect to find for your working diagnosis. For Case A: CSF analysis (state expected cell count, glucose ratio, protein, Gram stain/culture for each meningitis type); include blood culture, CBC, CRP, blood glucose. For Case B: EEG (state expected finding), MRI brain, metabolic screen (glucose, calcium, electrolytes). Construct a small comparison table if differentiating meningitis types. State the CSF:blood glucose ratio thresholds that differentiate bacterial (<0.4), TBM, and viral.

3. Evidence-Based Management Plan

Guidance: Outline the immediate (<1 hour) and subsequent (24-72 hours) management for your working diagnosis. State ALL drug doses in mg/kg. For Case A: empirical antibiotics (ceftriaxone + vancomycin, state doses and route), dexamethasone (state dose, timing relative to antibiotics, duration). For Case B: if focal epilepsy — first-line AED (carbamazepine or oxcarbazepine, mg/kg/day, state why carbamazepine is avoided in generalised/absence); what you would NOT give (carbamazepine in absence epilepsy) and why. Safety netting: danger signs for parents to watch.

4. Complications and Their Prevention

Guidance: For the working diagnosis, describe the TWO most important complications and how you would prevent or monitor for them. Case A meningitis complications: hearing loss (sensorineural — timing of dexamethasone is critical), hydrocephalus (monitor head circumference, signs of raised ICP), subdural empyema, SIADH. Case B epilepsy: status epilepticus risk (when to give rescue benzodiazepine — dose in mg/kg), medication adverse effects, impact on schooling and driving restrictions (relevant even for a 7-year-old — future counselling). Include parent/caregiver education points.

5. Preventive Strategy and Community Perspective

Guidance: Briefly discuss one preventive strategy relevant to your chosen case. For Case A: role of immunisation (PCV, MenACWY, Hib vaccines in National Immunization Schedule — India), chemoprophylaxis for meningococcal contacts (rifampicin 10 mg/kg/dose). For Case B: triggers to avoid (sleep deprivation, fever, flickering lights for photosensitive epilepsy), school notification, and when to restrict activities (swimming, cycling) until seizure-free for a defined period.

Grading Rubric — Paediatric CNS Case Writeup Rubric

Criterion	Points	Full-marks descriptor
Differential diagnosis and clinical reasoning (accuracy, prioritisation, justification from case findings)	20 pts	Correct working diagnosis; 3-4 differentials clearly prioritised with specific case findings cited as evidence; differential logic is flawless and clinically authentic.
Investigation plan with correct interpretation (CSF/EEG findings, glucose ratios, expected results)	20 pts	All essential investigations listed with correct expected findings; CSF:blood glucose ratio thresholds cited accurately for each meningitis type; EEG findings correctly described for seizure type; comparison table (if used) is accurate.
Management plan accuracy (correct drugs, weight-based doses, timing, and rationale for exclusions)	25 pts	Correct drug choices with accurate mg/kg doses for ALL medications; dexamethasone timing relative to antibiotics stated correctly; contraindicated drug (e.g. carbamazepine in absence) explicitly named and reason given; management is sequenced (immediate vs subsequent).
Complications and parent/caregiver education (clinically relevant, actionable, prevention-focused)	20 pts	Two relevant complications identified; each linked to a specific prevention or monitoring strategy; parent education points are specific, actionable, and appropriate for Indian primary-care context.
Preventive strategy and community perspective (immunisation/programme accuracy, counselling content)	15 pts	Correct preventive strategy with accurate NIS vaccine names and schedules, or accurate seizure trigger avoidance counselling; chemoprophylaxis dose cited in mg/kg if applicable; community/school aspects addressed.

PEER REVIEW

You will review one peer's assignment. Use the rubric above to score each criterion independently. For each criterion: (1) state the score you assign (out of the criterion maximum), (2) give ONE specific strength and ONE specific suggestion for improvement. For clinical accuracy review: if your peer stated a drug dose without mg/kg or used a drug contraindicated in the case (e.g. carbamazepine for absence epilepsy), flag this as a clinical accuracy issue. Complete your peer review within 48 hours of receiving the submission.