A 45 year old with seizures

A 45 year old male chicken shop owner by occupation was brought with c/o sudden onset of giddiness followed by LOC that was preceded by tonic UL movements f/b regain of consciousness at 4:30 pm on 18/5/22

HOPI-

Patient was apparently alright yesterday ,then developed 1 episode of sudden onset of giddiness f/b tonic movement of UL for 3 minutes f/b LOC for 15min . During period of LOC ,vertical uprolling of eyes +,tongue bite +,frothing+

H/o post ictal confusion for few seconds

No h/o aura preceding the events

No h/o involuntary micturition/defecation.

Past history -

N/K/C/O HTN,DM,BA,EPILEPSY,TB,CAD,CVA

Personal history-

Appetite -normal

Diet-mixed

B&B -regular

Addictions -patient has been consuming alcohol 15 years ago ,started occasionally which then increased to daily intake of 90ml

of whiskey since 3 years

General examination -

Pt is c/c/c

Bp-180/100mmhg

PR-128bpm

RR-18cpm

Grbs-248mg%

Systemic Examination-

CVS-S1,S2+

RS-BAE+,NVBS

P/A-soft,non tender

CNS-

HMF+

GCS-15/15

POWER

RT LT

UL- 5/5 5/5

LL- 5/5 5/5

Reflexes-

Rt Lt

B + +

T + +

S + +

K + +

A + +

P dorsiflexion

Diagnosis-

New onset seizures secondary to

?alcohol withdrawal

? Hypertensive urgency

Investigations-

MRI-No features suggestive of stroke

Small vessel is chemical changes seen

(Final report awaited)

Treatment given-

1.TAB NICARDIA 10mg PO/STAT

2.INJ LEVIPIL 500mg IV/STAT

3.INJ OPTINEURON 1AMP IN 100ml NS IV /STAT

Treatment at discharge-

1.TAB LEVIPIL 500mg PO/BD

2.TAB THIAMINE 200mgPO/OD

3.TAB NEUROBION FORTE PO/OD

4.TAB RESTYL 0.5mg PO/OD

5.TAB TELMA 20mg PO/OD @8AM

6.MUCOPAIN GEL FOR L/A

7.HOME BP MONITORING

Comments

medicine case

This is 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 patients clinical problems with collective current best evidence based inputs A 79yr male presented to casuality with chief complaints of pedal edema since 10 days , shortness of breath since 5 days Patient was apparently asymptomatic 10days back then came with c/o Pedal edema since 10 days -pitting type ,shortness of breath since 10 days insidious in onset , grade 3(marked limitation in activity) ,Fever 7 days back which subsided ,Dry cough 7 days back which subsided. PAST HISTORY - K/c/o hTN since 10 yrs on regular medication-telmisartan 40mg H/o CVA 10 yrs back for which he was treated. Not a k/c/o diabetes , TB,asthama,cvd , epilepsy. PERSONAL HISTORY - Diet - mixed Appetite - n

case presentation

This is an online e logbook to discuss our patients deidentified health data shared after taking her/guardian's signed informed consent Here we discuss our individual patient problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problems with collective current best evidence based inputs This E log also reflects my patient centre’s online learning portfolio and valuable inputs on the comment box is welcome. A 45 year old gentlemen ,from ramanapet who is farmer by occupation came to the OPD with CHIEF COMPLAINTS: B/l Pedal edema since 3 months Shortness of breath since 2 months HISTORY OF PRESENT ILLNESS: Patient was apparently asymptomatic 3 months back then developed pedal edema, insidious in onset, bilateral ,gradually progressive from involving ankles to limbs (grade1to grade 3 ), pitting type ,aggravated by walking and by end of the day,relieved by elevating leg, then developed shortness of breath w

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