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

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