A 5 year old boy was brought to emergency room with intractable convulsions. His mother said that he was playing in the swimming pool just before his friends noticed convulsion and he never had such condition before. On examination he was in coma with dilated non-reactive pupils

A five-year old physically active boy developed sudden paralysis of his left arm and leg. His mother believed that he has poliomyelitis because she was not regular with his vaccination. On examination in the emergency room he showed spasticity and hyperreflexia on his left arm and leg. Cardiac examination revealed systolic parasternal murmur.

A 2 year old boy with an otitis media is brought to casualty. His father reports that child has had a convulsive attack. Temperature is 39.8. The attack was very brief and his elder brother suffered the same when he was 18 months old. On examination, the child is active playful and alert.

A 3 months old infant brought to the emergency department because of vomiting and irritability of 3 days duration. Today the boy had seizures, temperature is 39 Cº, he has mottling of the skin, slow capillary refill and few petechiae. He has also decreased responsiveness, bulging fontanelle but negative kernig's and Brudzinski's signs

A 10 year old boy presented with impaired level of consciousness of 12 hours duration. The patient could be aroused for only short periods during which he can respond to simple verbal commands. The mother says he was perfectly normal when he went to play football with his neighbor. On arrival his hemoglobin 7 gram/dl, temperature 37.2, heart rate 55/minute, blood pressure 110/70

A 6 year old child is hospitalized for observation because of a short period unconsciousness after a fall from a poly ground swing. He has developed unilateral pupillary dilatation, focal seizures and hemiplegia.

An 11 year old boy presents in a confused state. He developed a fever 2 day previously and had been complaining of headache, fever and photophobia. He had vomited 3 times. On examination, his temp was 39.6 C and he has neck stiffness.