]> 2026-07-31T11:51:51+00:00 WBR1095 0 en Start antiepileptic medications. '''Incorrect''': Antiepileptic medications should not not be started before obtaining a lumbar puncture. Start broad-spectrum antibiotics. '''Incorrect''': First a lumbar puncture should be performed before starting antibiotics. Start steroids. '''Incorrect''': Steroids have not been proved to be the effective in meningitis except in Tb meningitis. Also a lumbar puncture is the best initial step in this case to rule out meningitis from encephalitis. Start with antiviral and antimalarial treatment together. '''Incorrect''': Before starting any antibiotic therapy or empirical treatment lumbar puncture must be performed to rule out meningitis from encephalitis. Order a Lumbar Puncture. '''Correct''': The best next step in the management of fever and seizures is doing a lumbar puncture to rule out meningitis from encephalitis. A history of fever and seizures in a 11 month old child is highly suggestive of an infection . Since the patient is from Haiti where malaria and other parasitic infection are endemic an empirical therapy of anti malarial should be started right away . Since the thick and thin smears are negative malaria is ruled out and other infectons should be thought about. The next step in the management is do a lumbar puncture and rule out other infection like meningitis from encephalitis. '''Educational objective''': Rule out encephalitis and meningitis before starting empirical therapy in a case of unknown sezirues with fever. Lumbar puncture is always the next best step in the management.<br/> '''Educational Objective:''' <br/> '''References:''' Chetan Lokhande An 11-month-old previously healthy African American female from Haiti comes to Emergency room (ER) with generalized tonic clonic seizures with 1-day history of lethargy, fever and altered mental status. Enroute to hospital, emergency medical team intubated her and gave a dose of lorazepam, with no remission. In the ER 1 more dose of lorazepam was given and patient was transferred to ICU for further management, where vitals were within normal limits. Overnight EEG showed a pattern of status epileptics. The patient was medically paralyzed and put on a ventilator. Complete blood count, Chem 10 and CT scan all are within normal limits. She was given a dose of quinine for malaria, but stopped due to negative thick and thin smear. What is the next step in the management of this patient? E Head and Neck Neurology Infectious Disease 2020-10-28T02:36:02Z 2459150.6083565 WBR1095