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16-month-old girl was transferred to a pediatric emergency department (ED) by ambulance from
another hospital's ED for fever and seizure. Prior to arrival, the accepting doctor obtained the
brief history that this girl had no known past medical history and was witnessed to have a
tonicclonic seizure at home lasting 20 minutes. The seizure stopped without intervention prior to
arrival to the outside ED. The patient had a recorded temperature of 103F and otherwise
ageappropriate vital signs. Her left pupil was 2mm and reactive; her right pupil was 5mm,
nonreactive, and appeared to be slightly extorted and depressed. One hour after the patient's
arrival in the ED, and 30 minutes after the mannitol and hypertonic saline administration, the
patient's repeat vital signs were: a temperature of 102F, a heart rate of 96 beats / min, a blood
pressure of 105/70mmHg, a respiratory rate of 25 breaths / min, and an oxygen saturation of 98%
on the ventilator. Her pupils appeared to be normalized to 3mm, both were reactive, and
pupillary tracking appeared normal. At this point, she was deemed stable to go to magnetic
resonance imaging (MRI). - Please describe the histological structure of the blood brain barrier
(BBB) and its function in the central nervous system. Draw and label a diagram of the BBB. 10
pts

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  • 1. 16-month-old girl was transferred to a pediatric emergency department (ED) by ambulance from another hospital's ED for fever and seizure. Prior to arrival, the accepting doctor obtained the brief history that this girl had no known past medical history and was witnessed to have a tonicclonic seizure at home lasting 20 minutes. The seizure stopped without intervention prior to arrival to the outside ED. The patient had a recorded temperature of 103F and otherwise ageappropriate vital signs. Her left pupil was 2mm and reactive; her right pupil was 5mm, nonreactive, and appeared to be slightly extorted and depressed. One hour after the patient's arrival in the ED, and 30 minutes after the mannitol and hypertonic saline administration, the patient's repeat vital signs were: a temperature of 102F, a heart rate of 96 beats / min, a blood pressure of 105/70mmHg, a respiratory rate of 25 breaths / min, and an oxygen saturation of 98% on the ventilator. Her pupils appeared to be normalized to 3mm, both were reactive, and pupillary tracking appeared normal. At this point, she was deemed stable to go to magnetic resonance imaging (MRI). - Please describe the histological structure of the blood brain barrier (BBB) and its function in the central nervous system. Draw and label a diagram of the BBB. 10 pts