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.

About 12 days after a mild upper respiratory infection, an 8 years old boy complains of weakness in his lower limbs. Over several days, the weakness progresses to include his trunk and respiratory muscles. Oxygen saturation is 85%.

A 10 year old child has developed headache that is more frequent in the morning. Over the previous few days his family noticed a change in his behavior, he becomes more irritable than usual. Neurological examination revealed hypertonia and hyperreflexia and positive planter reflex in both lower limbs

An 11 year old girl has a 4 month history of abnormal behavior in the form of repeated crying and abnormal movements. On the examination she has jerky involuntary, arrhythmic movements especially in the upper limbs. No history of previous drug intake. The rest of neurological examination is normal.