43 YEAR MALE WITH SEIZURES
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19.10.2021
43 YEAR OLD MALE WITH SEIZURES
A 43 year old male patient came to the casuality on 18/1021 at 8:20 pm with
c/o fever - low grade 1 episode yesterday
C/o sudden onset of involuntary movements of rt UL and LL
with frothing +,
LOC lasting for 10 mins with
post-icteal confusion +
PAST HISTORY:
43yr/male, unmarried, born to non-consanguineous marriage was diagnosed with poliomyelitis at age < 5 yrs , studied upto 6th standard and stopped school due to decreased attention and ? Memory
impairment , walked with support.
He attained all milestones normally.
He was given the job of taking care of cattle till his father expired around 5 yrs back.
Just before this he behaved unusually, talking to himself, wandering around, behaved aggressively for 1 week and was taken to yerragadda and was started on anti psychotics.
He was then made to stay at home, able to perform his own activities.
Patient was asymptomatic till 1 day ago, when he developed fever which was low grade, decreased on medication.
At 3:00 pm yesterday , after he finished having lunch, Pt suddenly developed one episode of Rt sided UL and LL involuntary movements with loss of consciousness for 10 mins, regained spontaneously; did not talk after that.
Following that he had 2 more episodes, each lasting for 2-3 mins, with one episode of vomiting.
He was treated outside with
inj Levipil 2g IV/ stat, catheterised and referred here.
Not a k/c/o HTN, DM
VITALS ON ADMISSION:
Temp- afebrile
Pulse- 92 bpm
BP- 140/90 mmhg
RR- 18 cpm
Spo2- 98% at RA
GRBS- 137 mg/dl
ON EXAMINATION:
CVS- S1 S2 +. No murmurs
RS- NVBS. No crepts
P/A- soft
CNS-
Drowsy but arousable
Speech- no response
GCS- G2 V2 M5
Pupils -NS sluggish r/n to light
Conjunctival reflex +
Corneal reflex +
Rt. Lt
Tone
UL Increased N
LL Increased. N
Power
UL. 4/5. 4/5
LL. 3/5 3/5
Reflexes
B. 2+ 2+
T 2+ 2+
S. - 2+
A. - -
K. - -
P. ^ Mute
INVESTIGATIONS:
ECG:
CHEST X-RAY:
MRI BRAIN:
Diagnosis:
Focal seizures ( Rt side ) with secondary generalisation secondary to cortical venous sinus thrombosis
with
H/o ? Psychosis
( on anti-psychotics)
TREATMENT IN HOSPITAL:
Ryles catheterisation
Inj lorezepam 2 cc/IV/ sos
Inj mannitol 100 ml IV/TID
W/H Antipsychotics
RT feeds- 50 ml milk 2nd hourly.
Day 2:
Inj mannitol 100 ml / IV/ TID
Inj Levipil 1 gm/ IV/ BD
Inj Lorazepam 2 cc/ IV / SOS
RT feeds- 50 ml water 2nd hourly
100 ml milk 4th hourly
Inj Monocef 1g IV/ BD
inj Enoxaparin 40 mg every 12th hourly
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