A 22 year old male with seizures



This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. 

Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. 

This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box is welcome.
Here is a case i have seen:

A 22 year old male patient,delivery boy by occupation came with C/O  headache since 2 months and involuntary stiffness of both upper and lower limbs 1 week ago lasting for 2 min associated with LOC.
HOPI:
patient was apparently asymptomatic  2 months  ago later he developed headache in the occipital region radiating to frontal region which was sudden in onset,progressive, associated with vomiting with food as content ,eye pain and neck pain, aggrevated on lying down serve in the early morning and relieved by medication.  

On Nov 14,In the afternoon after having lunch he was lying down then he again developed Headache followed by vomiting and further followed by  involuntary stiffness of both upper and limbs lasting for 2 min  associated with LOC for 5 min regained spontaneously,Not associated with uprolling of eyes,tongue bite, micturition, defecation,post ictal confusion.

1 week back  In the evening while he was having his tea he again had 3-5 such episode of seizures in the span of half an hour.

H/O on and off  fever since 1 year low grade ,
Present throughout the day subsides on taking medication.
H/O wieght loss since 6 months.
H/O alcohol consumption since 3 years (1 bottle of beer/day and toddy), tobacco chewing since 1 year(2 packets/day).
 No H/O HTN,DM,Asthama,CAD, Thyroid disorders.
 Mixed diet, decreased appetite since 6 months, adequate sleep,Bowel and Bladder regular.
No similar complaints in the family.

General Examination : 
patient is conscious, coherent, cooperative. 
No pallor, Icterus, Cyanosis,Clubbing,pedal Edema .
B/L supraclavicular lyphadenopathy (approx 1x1cm) , and left axillary lymphadenopathy approx 2x2 cm.

 Vitals : 
Afebrile , PR : 80 bpm regular,BP : 120/80mmHg,RR : 16 cpm.

Systemic Examination : 
CVS : S1 S2  heard, no murmurs.
RS : BLAE +, Vesicular breath sounds heard, decreased breath sounds in left suprascapular and interscapular region.On percussion dull note heard in left suprascapular region.
P/A : soft,non tender,no organomegaly.
CNS : 
Patient is conscious, coherent, cooperative, orientated to  person,time&place.
Speech normal 
According to above data:
Orientation-5/5
Registration- 5/5
Recall -5/5
Attention and Calculation -5/5
Language -5/5

Cranial Nerves : Intact
Superficial and Deep reflexes : normal 
Cerebellar Examination :
Gait : normal
Finger- nose test :normal
Finger-nose-finger test : normal
Heel to knee test : normal.

Investigations : 

HIV 1/2 : REACTIVE




Provisional Diagnosis : New Onset seizures pure tonic secondary to 
? Ring enhancing lesions in right cerebellum
? Tuberculoma

Treatment : 
Tab.LEVIPIL 500 mg OD 
Inj.THIAMINE  1 amp IM/OD
For further treatment ,
Sample sent for CD4 Count Waiting for reports
Sample sent  for CBNAAT waiting for reports

Popular posts from this blog

A 70/M potmaker by occupation with SOB since 3 months and B/L pedal edema since 2 months

Image
 70 year old male patient potmaker by occupation presented with C/O SOB since 3 months,B/L Lower limb swelling since 3 months Patient was apparently asymptomatic 30 years ago then he developed sudden  edema  of right upper limb involving upto elbow non pitting type then he had H/O thorn prick over the right palmar region 15 days ago due to which his edema of the right limb increased and was associated with pain but relieved on medication. H/O scrotal swelling since 20 years initially right sided gradual in onset   approximately a size of tennis ball ,got progressed to present size not associated with pain and appears to be B/L presently .3 months back patient developed SOB and got up from sleep in the night time. Since then he had SOB of grade III relieved on taking rest. Later he  observed B/L  pedal edema, pitting type intilally involving upto ankle joint  later progressed upto thigh region since  2 months. No H/O fever, chest pain, palpitations. K/C/O HTN since 3 months and on medic
Read more

Bimonthly Assignment

Image
) A 55 year old man with Recurrent Focal Seizures casehttp://ushaindurthi.blogspot.com/2020/11/55-year-old-male-with-complaints-of.html 1. What is the problem representation of this patient and what could be the anatomical site of lesion ? A 55 year old male came with A--1)Involuntary movements of right upper and lower limbs. 2)Right upper limb weakness 3)DM II 4)Chronic alcoholic and chronic smoker since 35 years. O/E :Clubbing +, bilateral Inspiratory crepts in all areas. B-- right temporal lobe epileptogenic focus.   2. Why are subcortical internal capsular infarcts more common that cortical infarcts? subcortical infarcts are more common than cortical infarcts because the penetrating arteries which supply them have small diameter and  arise from major arteries of greater volume at a certain angle that makes them more prone for occlusion and rupture.Thus making sub cortical infarcts more common.  3. What is the pathogenesis involved in cerebral infarct related seizures? 
Read more