A 51 YEAR OLD FEMALE WITH SEIZURES.

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I have been given this case to solve in an attempt to understand the topic of " patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan.

 

Patient came to casualty with chief complaints of Involuntary movements of both upper and lower limbs since 4 hours.

 HOPI: patient was apparently asymptomatic 30 years back, later she developed involuntary tonic and clinic movements of both upper and lower limbs for about 5 minutes ,not associated with micturition and stools on bed, and postictal confusion present for 5 minutes ,and LOC present at the time of episode,and later after 10 minutes of seizure free period,later developed second episode of seizure on the same day and later after 5 mins of seizure(same type) and after 10 mins of inactivity  and then again 3rd episode for about 5 mins and later stopped after 5 mins, no micturition and stools passage and later after one month ,similar episode and frequent seizures present (10 similar episodes in 20 years) after which they went to hospital for the similar complaints for which they recieved medication( not known) and used for 3 years and stopped and there was a seizure free period for 4 years and today developed with involuntary movements of UL and LL since 4 hours ,no uprolling of right upperlimb and lowerlimb.

PAST HISTORY: No h/o DM , HTN ,asthma,TB

FAMILY HISTORY : Not significant 

GENERAL EXAMINATION:

VITALS:

Bp-110/70 mmHg

PR-130bpm

Temp -98.5°F

SpO2- 74@RA

GRBS -180mg% @admission

CVS : S1 S2 +, Apex beat : 5th ICS mid clavicular line.

RS : BAE +, No crepts 

P/A : Soft, no tenderness . Bowel sounds +

CNS: 

Speech : No response

Level of consciousness : stuporous

No signs of meningeal irritation

Tone :              R.              L.     

UL                   N              N

LL                    N              N

Power :           R.             L

UL                    3/5.         4/5

LL                    4/5.          4/5

REFLEXES :  R.             L 

  Biceps :.       +++.        ++

  Triceps :.      +++.        ++

  Supinator :    +.            +

  Knee :.            +.            +

  Ankle :            +.           +

No pallor ,cyanosis,lymphadenopathy,Icterus, clubbing,oedema.

PROVISIONAL DIAGNOSIS : Seizures with ? Left Ischemic stroke in frontal and occipital lobe.

INVESTIGATIONS: 

Treatment:

1)Inj LEVIPIL 500mg /IV /BD

2)Inj OPTINEURON 1 amp in 100ml NS IV/OD

3)Inj. MANNITOL 100ml/IV/ slowly over 1 hour

4) tab.ECOSPORIN 75 MG BD