A 46 year old male presented with seizures to the hospital

This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. 

20/07/2022

Blog by Janhavi Virani 

Roll no 58 

46 year old male patient who is Presser by occupation resident of Miryalguda brought to casuality with chief complaints of 

— recurrent episodes of seizures since the day before 

— pain and swelling in right shoulder 

Patient was apparently asymptomatic 12 years back then he had his first episode of seizure , 6 months back he had 2nd episode of seizure, 2 days before presenting to opd he had 2 episodes and the day before he came to opd he had 8 episodes of seizure. 

He presented with recurrent seizures abrupt in onset , each episode is associated with bilateral upper and lower limb spasms, up rolling of the eyes , tongue biting and state confusion after episode. 

Tongue biting is associated with bleeding. 

Each episode lasting for 1 to 5 mins . 

Occurrence of seizures is after alcohol consumption , tobacco consumption, strenuous 

Not associated with aura , salivation , involuntary defecation and micturition. 

During Recurrent seizures —> patient fell down which led to dislocation of the right shoulder went to nearby government hospital and was referred to Kims . 

He had sudden onset of pain in shoulder which is Dragging type associated with swelling and bluish discolouration is skin around the shoulder 

No history of fever , headache , trauma , vomitng , 

Above history is explained by patient’s attendant . She is reliable. 

Past History- 

No history of  Diabetes Mellitus , Hypertension, asthma, tuberculosis, CAD 

12 years back he went through surgery for injury to right hand  in which his little and right finger of right hand was amputated . 

Family History-

No significant family history . 

Personal History - 

Diet : mixed 

Appetite : normal 

Sleep : adequate 

Bowel and bladder: regular 

Addictions : 

History of alcohol consumption since 25 years - 25 units / day since 20 years . 

History of tobacco consumption since 25 years - 5 packets / day 

GENERAL EXAMINATION - 

Patient is conscious, coherent, and cooperative 

Well built and moderately nourishment. 

Pallor - absent 

Icterus- absent 

Cyanosis - absent 

Clubbing- absent 

Edema - absent 

Generalised lymphadenopathy- 

Vitals - 

PR - 70 bpm

RR - 16 cpm

BP - 110/80 mmHg

Temperature- a febrile 

SYSTEMIC EXAMINATION- 

Cardiovascular system  

JVP - not raised 

Visible pulsations: absent 

Apical impulse : left 5th intercostal space in midclavicular line.

Thrills -absent 

S1, S2 - heart sounds heard 

Pericardial rub - absent

Respiratory system:

Patient examined in sitting position

Inspection:-

oral cavity- Normal ,nose- normal ,pharynx-normal 

Shape of chest - normal

Chest movements : bilaterally symmetrically reduced

Trachea is central in position.

Palpation:-

All inspiratory findings are confirmed

Trachea central in position

Apical impulse in left 5th ICS, 

Chest movements bilaterally symmetrical 

AUSCULTATION 

BAE+,  NVBS

Abdomen examination:

INSPECTION

Shape : normal 

Umbilicus:normal 

Movements :normal

Visible pulsations :absent

Skin or surface of the abdomen : normal 

PERCUSSION- tympanic

AUSCULTATION :bowel sounds heard

CNS - 

Higher mental function -

patient is conscious

oriented to time place and person .

Emotionally stable 

Speech : comprehension is normal , fluency is reduced as he had history of tongue biting during his episodes of seizures . 

Emotionally stable 

CRANIAL NERVE EXAMINATIONS - no abnormalities detected 

Motor system examination- 

Power                    Left

Upper limb             5/5

Lower limb            5/5

Tone.                     Left 

Upper limb        Normal   

Lower limb        Normal   

Reflexes - done only on left hand 

Bicep          

Tricep

Knee

Ankle

PROVISIONAL DIAGNOSIS- 

Status Epilepticus with Right shoulder dislocation. 

INVESTIGATIONS- 

ECG 

MRI Brain 

TREATMENT- 

Inj Levipil 500mg iv/bd 

Inj Thiamine 200mg 

Inj Monocef 1gm iv/bd

Inj PAN 40mg iv 

Inj ZOFER 4mg iv