Dysmorphology Course
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CONVULSION - PROBABLY TUBERCULOUS MENINGITIS SEIZURE

"The failure of the apostles to exorcise ", 1528 Giovan Francesco Penii El Prado Museum, Madrid, Spain

This is a copy by Giovan Francesco Penii

The original was painted for the cathedral of Narbona by order of Cardenal Giulio de Medici. This work depicts the failure of the apostles to exorcise or free a victim from the Devil. 

From my point of view the patient has epileptic convulsions and a deviated eye (strabismus squint). Ocular deviation toward the upper external quadrant may be a sign of tuberculous meningitis - compression of the VI cranial nerve known as "pathetic". This form of meningitis can be chronic and difficult to suspect and therefore to diagnose. One of the most constant signs is headache (cephalea) and less frequently sensitivity to light (photophobia), and in some patients chronic constipations. Genrally the onset of tuberculous meningitis is gradual. Nausea and vomitting are particularly common in other more acute forms of meningitis.

Relevant keywords include: MENINGITIS TUBERCULOSIS TUBERCULOUS CHRONIC GRADUAL HEADACHE CEPHALEA CONSTIPATION CONFUSION IRRITABILITY DROWSINESS STUPOR COMMA STRABISMUS SQUINT PARALYSIS HEMIPARESIS HYDROCEPHALUS.

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