65 year old male with focal seizures
65 year old male with involuntary movements and focal seizures
respiratory rate:20cycles/min
Pulse rate:120bpm
No x ray abnormalities are seen
Diagnosis
Final exam short case
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Date of admission:18/01/2023
Cheif complaint
A 65 year old male bought to causality with complaints fever and involuntary movements of left upper and lower limbs since 4pm on 18/01/2023
History of present illness
Patient was apparently asymptomatic 2 years back then he had episodes of seizures in between ,and on 18/1/2023 then he developed fever epidode till 6pm ,which was relieved by medication
history of 3 episodes of seizures from 2 years
1st history on 11/07/2021
2nd history on 13/03/2022
3rd history on 18/04/2022
4th history on 18/01/2023
History of hyperglycemia since 6 years
History of hypertension since 3 years,
History of CAD
Then he developed involuntary movements of left upper and lower limbs and associated with unrolling of eyeballs and drooling of saliva
Also complaints of tongue bite during seizure episodes
And also involuntary micturation in clothes
There is no regain of consciousness during episodes of seizures
History of past illness
history of 3 episodes of seizures from 2 years
No history of asthma,tuberculosis
1st admission was found to be due to high GRBS
Patient has a history of CVA on 14/7/2021
Patient was previously admitted in hospital 1 and half year back with bilateral upper and lower limbs weakness and muscle twitching
He also has history secondary to cva which resolved after few months then he again got admitted in hospital with loss of speech and unresponsiveness
Personal history
Occupation:farmer
Married
Apatite:normal
Diet:mixed
Micturation:involuntary
Sleep:adequate
Bowel movements:normal
Addictions: no Addictions
No known case of allergy
Family history
No relevent history of diabetes, seizures
History of hypertension present
General examination
Patient is conscious, non coherent, non cooperative
Not oriented to time, place,
Patient is Moderately built,Moderately nourished
There are no signs of pallor,icterus, cyanosis clubbing ,lymphadenopathy, oedema
Vitals:
Pulse rate:120bpm
Blood pressure:- 140/100mmhg
GRBS:- 201mg%
Systemic examination:
Cvs:s1,s2 are heared
No thrill, no bruit
Respiratory system:position of trachea is central
No dyspnoea
No wheeze
Vesicular breath sounds are heard
Bilateral air entry is normal
Abdomen:non tender
No palpable spleen and liver
CNS
Patient is drowsy
Not oriented to time,date,but oriented to person
Speech is slurred
Neck stiffness is present
Motor system:
Bulk of the muscle:normal
Tone:right upper limb normal
Right lower limb normal
Left upper limb decreased
Lower left limb also decreased
Power
Upper limb 4/5left,5/5right
Lower limb 4/5 left,5/5 right
Reflexes
Right Left
Biceps + +++
Triceps + +++
supinator + ++
Knee + ++
Ankle - ++
Plantor reflex- -
Cerebellar signs no finger nose coordination
No knee heel coordination
Examination of oral cavity: tongue bite is seen
Neck stiffness is seen
Provisional Diagnosis
Focal seizures with secondary generalisation
H/o HTN,DM
Investigations
18/01/2023
19/01/2023
6/08/2021
13/3/22
No x ray abnormalities are seen
Diagnosis
Focal seizures with secondary generalisation
H/o diabetes mellitus since 6 years
,hypertension since 3 years
Treatment
Iv monocef 1gm bd
Tablet phenotoin 100mg RT once a day
B complex 1 ampule iv od
Tablet telma 40mg RT once a day
Sodium valproate 1000mg RT bd
Tablet ecospirin +atorvas 75/10 h/s once a day
Tablet dolo650 rt tid
Injection kcl 2ampu iv od
Ivf DNSand RL 100 ml
