A CASE OF FOCAL SEIZURE
A 40 year old Male from Nalgonda came to the casualty
CHIEF COMPLAINTS
Seizure activity
HISTORY OF PRESENT ILLNESS
The patient was apparently asymptomatic 5-6 months back when he had 5 episodes of seizure -Focal [right sided] with secondary generalization which is associated with involuntary micturition for which he was taken to a local hospital and got treated symptomatically
The patient was referred to one hospital for further treatment
Patient was brought to casualty in a state of altered sensorium
GCS :E3 V4 M5
Patient has history of generalized weakness and body pains since 1 day
there are no other complaints
PAST HISTORY
No history of Diabetes mellitus
Hypertension
Coronary artery disease
Asthma
Tuberculosis
PERSONAL HISTORY
Married
Normal appetite
Regular bowels
Daily wage labourer
Habits: Alcohol from past 20 years 180ml/day
Smoking Cigeratte from past 20 years 15/ per day
FAMILY HISTORY
There are no notable family history
EXAMINATION
General examination
NO Pallor
NO Ictrus
NO Cyanosis
NO Koilonychia
NO Lymphadenopathy
NO Edema
Temperature:100F
Pulse rate :96 /min
Spo2 at room air 99%
SYSTEMIC EXAMINATION
CVS
S1 and S2 heard
there are no murmurs
RESPIRATORY SYSTEM
Normal vesicular breath sounds,
No wheeze , No dyspnea ,
No wheeze , No dyspnea ,
trachea is central
ABDOMEN
Shape of abdomen - Scaphoid
No tenderness
No palpable mass, fluid , bruit
No palpable liver , spleen
P/R : no
CNS
Is Drowsy
Incoherent
Glasgow scale E3V4M5
Reflexes
Right arm :slight increase in intensity
Left arm :slight increase in intensity
Both right and left knee : exaggerated reflex
Plantar reflex: unelicitable
INVESTIGATIONS
Complete urine examination
Hemogram:
Hemoglobin- 12.9 gm/dl
Total count -19000 cells/gm
Lymphocytes -13 %
PCV -38.1vol %
RBC count -4.42 millions/cumm
Electrocardiogram
TREATMENT
Inj CEFTRIAXONE 1 gm IV
Inj LEVIPIL 500mg IV
Inj LORAZ 2cc IV
Inj THIAMINE 1 amp 100 ml NS IV
Inj OPTINEURON 1 amp 100 ml NS IV
Tab DOLO 650 mg
PROVISIONAL DIAGNOSIS
FOCAL SEIZURE WITH SECONDARY GENERALIZATION
ALTERED SENSORIUM UNDER EVALUATION
? Meningo encephalitis
?Septic encephalopathy
PLAN
CSF analysis
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