A 26 year old female with SEIZURES

25 December 2021

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 Elog book also reflects my patient-centred online learning portfolio and your valuable inputs on the comment .

Patient and his/her attenders have been informed and their consent has been taken.

SNEHA JAJU

Roll no 148

30year old female with chief complaints of involuntary movements 7-8 days back.

HOPI

Patient was apparently normal till 7years back, then she was emotionally traumatized and physically assaulted by her husband who bet her on the neck following which she had loss of consciousness then she was taken to near by hospital where she had 2 episodes of vomitings. CT scan then showed some lesion in brain and adviced MRI brain and got it done at KIMS-NKP and treated with some medication for month then stopped.

Now 7-8 days back patient had tension and emotional conversation with husband and sister-in-laws and was weeping following which she suddenly became light headed and fell down with involuntary movements of both upper limbs and lower limbs with up rolling of eyes with 1 hour of post ictal confusion. Then she became unconscious for brief period and was taken to local hospital from their refered to higher center, since then she felt weakness of right upper limb and lower limb with tingling sensation and was complaining of paralysis of whole of Right side.

H/o fall on head when she was 4-5 years old. Bleeding was stopped by applying turmeric and bandage. She was not medically treated at that time. She had no complaints at that time.

H/o 4 medical termination of pregnancy(medical).

1 MTP (surgical/evacuation in 4th month) 

PAST HISTORY 

Not a k/c/o HTN, DM, Asthama, Thyroid.

FAMILY HISTORY

Not significant

TREATMENT HISTORY

Was on OCP

Local RMP gave LEVIPIL 

PERSONAL HISTORY

 Diet - Mixed

Appetite - Normal

Sleep - Disturbed when she takes stress

Bowel and bladder movements -regular

No known allergies

No addictions

GENERAL EXAMINATION

Patient was conscious, coherent and cooperative. Well oriented to time, place and person.

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

Vitals-

 Temp: afebrile 

PR- 70bpm    

RR- 18cpm

BP- 110/80 mmHg

Spo2 -98%at RA

SYSTEMIC EXAMINATION

CVS-  S1  S2 heard, no murmurs, no thrills

RS - NVBS heard

P/A - Soft, non tender

CNS- Speech normal

Tone of both upper and lower limbs- normal

Power of R UL-5/5.      L UL-5/5

Power of L UL -4/5.      R UL- 5/5

REFLEXES- 

           B.   T.      S.     K.    A

R.       +3.  +3.   +3.   +3.   +3

L.        +3.  +3.   +3.    +3.   +2

INVESTIGATIONS

Hb- 10.4.    Tlc- 12000.    Plt- 3.69

LFT:

TB- 0.71    DB- 0.16.    AST/ALT - 14/13

ALP-151.   TP- 6.7.   Alb- 4.2

U-15.    S.Cr- 0.8.   Na+148.  K+ 3.8.   Cl-107

PROVISIONAL DIAGNOSIS 

Seizures under evaluation.

TREATMENT

1. Tab PANTOP 10mg OD

2. Inj OPTINUERON 1ampole in 100ml NS IV OD

3. Inj LORAZEPAM 2mg OD

4. W/F Seizure activity

5. BP/PR/Temperature monitoring 4th hourly

6. GRBS monitoring 12th hourly

7. Tab LEVIPIL 500mg PO BD