Chief complaints : Involuntary movements of bilateral upper and lower limbs 2 days back
History of presenting illness : patient was apparently asymptotic since 8 days back
then she developed fever which is insidious in onset , low grade type and subsided on taking medication .
Associated with wet cough ,body pains ( lower limbs dragging type of pain)
Breathlessness (Grade 4)
fever is not associated with chills or rigors.
on investigating the patient is tested positive for NS 1 antigen
on 26th march ,around 5.00 am patient developed seizures with up rolling of eyes and drooling of saliva which lasted for 2 mins after which she regained consciousness
no involuntary micturition, defecation , tongue bite , aura , post ictal confusion.
no history of Pain abdomen
No H/o, loose stools , giddiness, hematuria
No rash & bleeding manifestations .
No H/o retro orbital pain , joint pains
Past history: 1 seizure episode after the delivery of her first child (5 yrs back) without loss of consciousness .
No h/o T.B , DM , Hypertension, Asthama
personal history: Diet - mixed
Appetite - normal (decreased during fever)
sleep - adequate
Bowel movements - regular
Bladder - normal
Addictions - none
Obstetric history : 2 term deliveries (lscs)
5 yrs and 2& 1/2 yrs back
No H/o Hypertension during pregnancy
History of one seizure episode on second day after her first delivery.
Menstrual history: attained menarche at 12 yrs regular cycles
30 days cycle not associated with pain and clots
Family history : Her family members were tested positive for dengue
Treatment history : 1 week back she was admitted in ICU for fever
Transfusion history : on 22nd 1 unit was transfused for low platelet count.
General Examination
Patient is conscious, coherent and cooperative and was examined in a well lit room with informed consent.
VITALS at the time of admission
Temperature : Aferbile (currently 98.5°F)
PR : 94bpm
RR : 20cpm
BP : 110/80 mmHg
SPO2 : 94%
Grbs : 115 mg%
No Pallor, icterus, cyanosis, clubbing, lymphadenopathy, peadal edema.
Systemic examination
CNS
Higher mental function : intact
Cranial nerve examination : normal
Motor system:
•Muscle Bulk R L
Inspection Normal Normal
Palpation Normal Normal
•Measurements
upper limb 28 cms 28 cms
lower limb 31 cms 31 cms
•Muscle tone
upper limb Normal Normal
lower limb Normal Normal
•Muscle power
upper limb 5/5 5/5
lower limb 5/5 5/5
•Reflexes
superficial - present
Deep - present
No involuntary movements
SENSORY SYSTEM normal
•CVS
s 1 s 2 heard
no added sounds
• RESPIRATORY SYSTEM
Position of trachea central
chest symmetrical
Chest expansion symmetrical
R L
percussion resonant resonant
Auscultation decreased breath sounds on right side .
no abnormal sounds
Abdominal examination
abdomen is soft , no organomegaly , no ascites
INVESTIGATIONS
18th march
20th march
21st march
22 March
23rd March
24th march
X ray
USG
27th march
Diagnosis
Dengue with seizures(clonic type) and Right sided pleural effusion
Treatment
inj.levipil 1gm in 100ml NS IV
inj Pan 40 mg IV stat
IVF NS , RL 75 ml / hour with 1 amp of Optineuron
inj.Pan 40 mg IV per OD
inj. Zofer 4 mg /IV /sos
inj. Neomol 100 ml (if temp> 101.1 ° F)
Tab. PCM 500 mg/PO/ TID
Tab. levipil 500 mg PO/ BD
Inj .Lorazepam 2cc/IV/SOS
