BRIEF HISTORY:
A 17 years old female,came to casuality at 2:28pm, with complaints of involuntary moments of both upper limbs and lower limbs since 12:00pm
She was apparantly assymptomatic ,till the age of 6 years and then she developed fever with chills for one day,and followed by which she developed involuntary moments of upper limbs and lower limbs,for about 5-10 minutes and associated with up rolling of eyeballs ,no micturition and no defecation and no frothing from mouth,and followed by which they have taken to local hospital followed by which,they received medication (no records available)and the seizures resolved,and they stayed in the hospital for 8 days and afterwards left home,they developed similar episodes frequently once in every 5-6days,followed by which they visited multiple hospitals,(no documents available ) and in 2018 they got a CT brain done and showed,Hemiatrophy of right cerebral hemisphere secondary to gliosis of right frontal and parietal lobes,and was diagnosed as post viral encephalitis,and was started on Tab valproate 300mg Po Bd
After which they visited to another hospital as she was micturiting following each seizure episode,and they’ve started on Tab.lamotrigine 50mg
She was on that medication since 5 years
She was born by FTNVD,and cried immediately after birth,her birth weight being 2.25kgs and no hospital admission immediately after birth,and achieved milestones according to her age .
And at 6years of age(studied till nursery and stopped,as mother is giving recurrent falls(due to decreased power in both limbs and due to recurrent seizures)
She stopped taking valproate since 2 months and lamotrigine since 15days
And since 15days her involuntary moments were increased,2-3times in a day,each episode(tonic and clonic) for every 5-10minutes followed by post ictal confusion ,and then she was taken to another hospital yesterday afternoon and adviced a scan but as the patient is not cooperative they kept her on iv drugs?sedation ,and the patient attenders have taken her home yesterday night.
And since today afternoon,she is having brief periods of involuntary moments of UL and LL ,one for every 5-10seconds,only tonic with up rolling of eye balls,and no tongue bite,and micturition and defecation.
She attained her menarche at the age of 13years,her cycles were irregular,once in every 2-3months.
She has an younger brother,who is studying 8th standard.
She has disturbed sleep since 1 month(used to sit in the bed at night times)
At the time of presentation ,she was in a confused state and
BP: 100/80mmHg
PR:115bpm
CVS:s1 and S2
TEMP:98.8F
CNS:patient is confused
Her tone and reflexes were normal.
Power wasn’t elicited
Metabolic profile was normal
She developed 5-6 brief episodes of seizures since admission
(HISTORY ACKNOWLEDGEMENT - Dr.Haripriya ma'am)
INVOLUNTARY MOVEMENTS of B/L
UL & LL - 1 EPISODE 30 MINS AGO.(NO TONGUE BITE,FROTHING, INVOLUNTARY MICTURITION. POST ICTAL CONFUSION PRESENT)
HOPI: PATIENT WAS APPARENTLY NORMAL TILL THE AGE 6 YEARS ,THEN SHE SUDDENLY DEVELOPED SEIZURES WHEN SHE HAD HIGH GRADE FEVER . LATER EPISODES OF SEIZURES WERE SUBSIDED AFTER TAKING MEDICATION. 1 EPISODE ONCE IN EVERY 10-15 DAYS. FROM LAST ONE WEEK SHE IS HAVING SEIZURES DAILY EPISDOE LASTS FOR 10 - 15 MINS. NO TONGUE BITE ,NO FROTHING NO INVOLUNTARY BOWEL AND BLADDER MOVEMENTS.
PAST HISTORY: N/K/C/O DM,HTN,TB,ASTHMA.
H/O SIMILAR COMPLAINTS FROM THE AGE OF 6 YEARS.
TREATMENT HISTORY:
PERSONAL HISTORY: SINGLE
APPETITE - NORMAL
DIET- MIXED
BOWELS- REGULAR
MICTURITION - NORMAL
NO KNOWN ALLERGIES
NO ADDICTIONS.
FAMILY HISTORY : SIMILAR HISTORY IS SEEN IN HER GREAT GRAND FATHER.
PHYSICAL EXAMINATION:
NO PALLOR, CYANOSIS, CLUBBING, LYMPHADENOPATHY, ODEMA
VITALS
TEMPERATURE - 98.8 F
RR- 19 CPM
PR- 119BPM
BP- 100/80 MM OF HG
SPO2 - 98%
GRBS- 116 MG/DL
CVS: S1,S2 +
NO THRILLS
NO MURMURS
RS:
TRACHEA CENTRAL
BAE+
NVBS
ABDOMEN:
SCAPHOID
NO TENDERNESS
NO ORGANIMEGALY
BOWEL SOUNDS HEARD
CNS:
DROWSY
SPEECH - NO RESPONSE
NO SIGNS OF MENINGIAL IRRITATION
NO NECK STIFFNESS
CNS-
RIGHT LEFT
TONE :
UPPER LIMB: NORMAL NORMAL
LOWER LIMB : NORMAL NORMAL
REFLEXES:
BICEPS : 2+ 2+
TRICEPS: 2+ 2+
SUPINATOR : 2+ 2+
KNEE : 2+ 2+
ANKLE : 2+ 2+
POWER: CANNOT BE ELICITED SINCE PATIENT WAS UNCONSCIOUS
DIAGNOSIS:
? STATUS EPILEPTICUS
KC/O EPILEPSY since 10 years.
TREATMENT :
1.INJ.LEVIPIL 1 Gm IV STAT IN 100 ML NS F/B 500 MG BD
INVESTIGATIONS
1/12/2022
ECG 8.40 PM
2/12/2022
ECG 7.40 AM
You can see the patient having seizures at
1.11 seconds
2.34 seconds
3.56 seconds
5.24 seconds
6.52 seconds
8.15 seconds
9.45 seconds
10.51 seocnds
12.18 seocnds
13.50 seconds
2/12/2022
S: 1 episode of ?tonic seizure ? pseudoseizure
O: PT IS C/C/C
TEMPERATURE -98.1 F
BP- 110/80 MM OF HG
PR- 91 BPM
SPO2- 98%
GRBS-141 MG /DL
CVS- S1,S2+
R/S - BAE +
P/A - SOFT ,NON TENDER
CNS-
RIGHT LEFT
TONE :
UPPER LIMB: NORMAL NORMAL
LOWER LIMB :NORMAL NORMAL
REFLEXES:
RIGHT LEFT
BICEPS : 2+ 2+
TRICEPS: 2+ 2+
SUPINATOR : 2+ 2+
KNEE : 2+ 2+
ANKLE : 2+ 2+
POWER: CANNOT BE ELICITED SINCE PATIENT WAS UNCONSCIOUS
A: ?STATUS EPILEPTICUS
K/C/O EPILEPSY SINCE 10 YEARS
P:
1. INJ. LEVIPIL 500 MG IV /BD
2.INJ. LORAZEPAM 2 CC IV /SOS
3.INJ.OPTINEURON 1 AMP IN 100 ML NS IV OVER 30 MINS.
4.INJ. SODIUM VALPROATE IV 500 MG BD.
