55yr Female came With Seizures
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A 55 YEAR OLD FEMALE PATIENT LABOURER BY OCCUPATION CAME TO CASUALTY WITH H/O 6 EPISODES OF SEIZURES SINCE YESTERDAY .
SHE GOT ADMITTED IN KHL AND TOOK MEDICINES AND GOT RELEIVED.
HOPI :-
H/0 TRAUMA ( FALL FROM TRACTOR WHILE GETTING DOWN) ON 8/2/22 i.e TUESDAY MORNING. SHE WAS
YESTERDAY 9/2/22 SHE HAD HER 1ST EPISODE OF SEIZURES AT 5 AM AND WENT TO RURAL COMMUNITY PHYSICIAN DOCTOR AND FOUND TO BE HYPERTENSIVE.
SHE HAD ANOTHER 4 EPISODES OF INVOLUNTARY MOVEMENTS OF LEFT UPPERLIMB AND LOWER LIMB WITH DEVIATION OF MOUTH TOWARS RIGHT AT HER HOME AND WENT TO CITY HOSPITAL FOR TREATMENT .
SHE HAD ANOTHER 6th EPISODE OF SEIZURE AT HOSPITAL .
SHE CAME TO OUR HOSPITAL AT 5 PM (as it it near to her Location of her House )
- NO H/0 LOSS OF CONSCIOUSNESS PRESENT DURING THE SEIZURES
- NO H/O VOMITING , ENT BLEED , HEADACHE
- NO EXTERNAL HEAD INJURY.
TREATMENT HISTORY :
CLOPIDOGREL
ROSUVOSTATIN
LEVITRACETAM
( Given Outside )
She Has Undergone Tubectomy 25 years Back.
PERSONAL H/O :
She Has 4 Child - 2 Male & 2 Female.
She wakes up 5 Am she does her household work at 8 o clock she goes to labour work ( lifting Mund and Dumping in tractor ) takes lunch at 1pm returns home at 5 o clock she cooks food & Sleeps at 9pm.
APPETITE - NORMAL
BOWELS - REGULAR
MICTURITION - NORMAL
ADDICTIONS :- NO ADDICTIONS
FAMILY H/O :- NOT SIGNIFICANT
VITALS
HR - 65 BPM
RR - 20 CPM
BP - 130/90 MMHG
SPO2 - 98 % RA
**RS - BAE PRESENT
**CVS - S1S2 PRSENT
**CNS - RIGHT LEFT
1) TONE UL NORMAL NORMAL
LL NORMAL NORMAL
2) POWER UL 5/5 4- /5
LL 5/5 5 /5
3) HANDGRIP N DECREASED
4) REFLEXES
a) BICEPS + +
b) TRICEPS + +
c) SUPINATOR + +
d) KNEE + +
e) ANKLE + +
f) PLANTAR + +
** PA - SOFT NON TENDER
INVESTIGATIONS
MDCT SCAN BRAIN-PLAIN
IMPRESSION :-
Hypodense lesion in right fronto parietal lobe.
D/D: - Vasogenic edema
- Hypodense contusion
- Infarct
MRI BRAIN PLAIN
IMPRESSION
✓ Focal gyrus diffusion restriction in right precentral (Knob's area) with adjacent white matter edema. F/S/O Post ictal edema.Less likely to be cortical infarct.
✓ Suggested follow up MRI Brain after 3months.
ECG
CHEST XRAY PA VIEW
XRAY PELVIS
2-D Echo
2D Echo Link - https://youtu.be/GmkfZgPmlfs
CAROTID DOPPLER
SERUM LIPID PROFILE
1) TOTAL CHOLESTEROL - 146
2) TRIGLYCERIDES - 144
3) HDL - 41
4) LDL - 90
5) VLDL - 28
HAEMOGRAM
Hb - 10
TLC - 9400
PCV - 30.2
PLT - 4.9 Lakh
RFT
BLOOD UREA - 20
S CREATININE - 0.7
Na - 141
K - 3.7
Cl - 101
LFT
TB - 0.5
DB - 0.13
SGOT - 25
SGPT - 10
ALK Ph - 184
TP - 6.1
Alb - 3.2
A/G - 1.16
PROVISIONAL DIAGNOSIS :-
SEIZURES WITH LEFT UPPER LIMB MONIPARESIS SECONDARY TO
? ACUTE ISCHEMIC STROKE IN FRONTO PARIETAL REGION
? VASOGENIC EDEMA
? HYPODENSE CONTUSION
? INFARCT
TREATMENT PLAN :
1) INJ LEVIPIL 1 GM STAT
2) INJ LEVIPIL 500 MG BD
2) INJ ONDONSETRON 4 MG IV STAT
3) TAB CLOPITAB A 75 MG PO OD
4) TAB ROSOVAS 10 MG PO OD
DAY - 2 WARD 55yrs/F
S : C/O DIFFICULTY IN HOLDING OBJECTS IN LEFT HAND
0 :
TEMP - AFEBRILE
BP - 130/90 MMHG
PULSE - 86 BPM
CVS -S1S2+, NO MURMURS
RS - BAE +
PA - SOFT, NON TENDER
A : SEIZURES WITH LEFT UPPER LIMB MONIPARESIS SECONDARY TO
? ACUTE ISCHEMIC STROKE IN FRONTO PARIETAL REGION
? VASOGENIC EDEMA
? HYPODENSE CONTUSION
P
1) INJ PAN 40 MG IB/OD
2) INJ OPTINEURON 1 AMP IN 100 ML NS / IV/OD
3) PHYSIOTHERAPY OF LEFT UPPER LIMB
4) TAB CARBAMAZEPINE 200MG /PO /BD
DAY - 3 WARD 55yrs/F
S : C/O DIFFICULTY IN HOLDING OBJECTS IN LEFT HAND
0 :
TEMP - AFEBRILE
BP - 140/90 MMHG
PULSE - 86 BPM
CVS -S1S2+, NO MURMURS
RS - BAE +
PA - SOFT, NON TENDER
A : SEIZURES WITH LEFT UPPER LIMB MONIPARESIS SECONDARY TO
? ACUTE ISCHEMIC STROKE IN FRONTO PARIETAL REGION
? VASOGENIC EDEMA
? HYPODENSE CONTUSION
P
1) INJ PAN 40 MG IB/OD
2) INJ OPTINEURON 1 AMP IN 100 ML NS / IV/OD
3) PHYSIOTHERAPY OF LEFT UPPER LIMB
4) TAB CARBAMAZEPINE 200MG /PO /BD
Day – 4 ward 55yrs/f
S : c/o difficulty in holding objects in left hand
0 :
MRI BRAIN PLAIN Done On 12/2/22
IMPRESSION:
✓ Focal gyrus diffusion restriction in right precentral (Knob's area) with adjacent white matter edema. F/S/O Post ictal edema.Less likely to be cortical infarct.
✓ Suggested follow up MRI Brain after 3months.
Temp – afebrile
B – 140/90 mmhg
Pulse – 86 bpm
CVS -s1s2+, no murmurs
RS – bae +
PA – soft, non tender
A : seizures with left upper limb moniparesis secondary to
? acute ischemic stroke in fronto parietal region
? vasogenic edema
? hypodense contusion
P
1) inj pan 40 mg ib/od
2) Inj Mannitol 5 % Iv /OD
3) inj optineuron 1 amp in 100 ml ns / iv/od
4) physiotherapy of left upper limb
5) tab carbamazepine 200mg /po /bd
