A FORGOTTEN ENTITY

FIFTH DAY FITS

Abstract

Rotavirus infection other than gastrointestinal manifestations is also known to cause systemic manifestations particularly involving the central nervous system in newborns. Rotavirus associated benign convulsions is characterized by a febrile brief tonic clonic to multifocal seizures between the 1^st to 5^th sick days of illness, tending to occur repetitively. The main findings are an  apparently healthy term newborns with seizures between 4 to 6 days of life in the absence of Gastroenteritis. Rotavirus is found only in stool specimens with no evidence of CSF pleocytosis and a  characteristic diffusion-weighted imaging (DWI) pattern on MRI. The activation of brain microglia which release reactive oxygen and nitrogen species and cytokines which are toxic to the premyelinating oligodendrocytes is the principal initiating event in systemic infection/inflammation leading to White matter injury. The present study reports one such case of a term healthy newborn who presented to us on the 5^th day of life with multifocal clonic seizures in the absence of gastroenteritis. Rotavirus was detected in stool specimen. CSF did not reveal any pleocytosis and rotaviral PCR was negative in CSF.MRI showed characteristic white matter injury on Diffusion weighted imaging.Clinical suspicion with the above clues clinches the diagnosis. Prognosis is good and treatment is motly symptomatic. Long term anticonvulsants are often not required