I saw an interesting patient today.
A mother brought in her baby. She was lethargic, not eating or drinking very much, apyrexial (temperature not high when seen in the paediatric department) and no rashes.
After taking the history I went on to examine her.
She seemed lethargic on the examining table, not responding quite right.
Listening to her chest was unremarkable.
I felt her abdomen which was also unremarkable.
I looked in her ears and throat which was unremarkable.
I felt her anterior frontanelle…..it felt a little tense, slightly bulging.
The anterior frontanelle bulges when intracranial pressure is increased in babies
Because of the bulging frontanelle we performed blood tests, lumbar puncture and started IV antibiotics. Our investigations revealed a meningococcal sepsis – a severe form of brain infection which can be lethal if not treated promptly.
In retrospect, I find it absolutely incredible that because of such a subtle examination finding – one that requires having felt hundreds of normal frontanelles – a life has been saved.
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