An 8-year-old, previously healthy girl was admitted after a 2-hour, sustained right-sided focal seizure, which responded to diazepam (Valium) and phenytoin sodium (Dilantin).
The medical history was positive for recent dental work and a viral upper respiratory tract infection, but negative for fever, ingestions, head trauma, or lesions suggestive of herpes. There was no recent travel outside the United States.
The patient's medical history was negative for perinatal insults or a known seizure disorder. There was no history of exercise intolerance, cyanosis, or hemoptysis.
Pertinent findings on the physical examination included an alert, well-nourished 8-year-old girl weighing 23.5 kg. Her cardiac examination results included a regular heart rate, with a regular rhythm. On cardiac auscultation there was a normal S1, a physiologically split S2, and a grade 2/6 fairly harsh, late-peaking systolic murmur, best heard at the apex, and radiating to the axilla. There was no gallop. Pulses