A 24 year old female with acute repetitive seizures
Unit 4 admission:
A 24 year old female who is a housewife resident of nalgonda came to the casuality with the complaints of :
- Involuntary movements of bilateral upper and lower limbs since 3 days
- Headache since 3 days
Patient was apparently asymptomatic 3 days back. Then on 17/ 08/21 at 12: 00 am , husband observed involuntary movements of bilateral upper and lower limb ( during sleep) GTCS type , up rolling of eyes, frothing present , one episode lasting for 5 to 10 minute. After seizure episode pt had one episode of vomiting contained food particles , non bilious, non blood stained , non projectile Post ictal confusion present .
No involuntary defecation , micturition. she was taken to a nearby local hospital and was given IV fluids with eption tablets . Later she got discharged. After returning home , she had another episode of bilateral involuntary movements of upper and lower limb. She was taken to miryalaguda hospital and was given IV levipil 1gm IV stat and underwent mri brain , it showed normal. Routine blood investigations were done which showed low Hb .seizures free for 20 hrs . Today afternoon at 9.40 am patient had bilateral involuntary movements of upper and lower limb with uprolling of eyes. Post ictal confusion is present. When she came to casuality after few minutes she had involuntary movements of rt upper limb with uprolling of eyes lasted for 5 min with post ictal confusion .
No H/o fever, chest pain , sob, palpitations,t pedal edema , burning micturition .
She is married. Three years back she gave birth to a baby. 1 yr back she got aborted due to bleeding .
Past history:
Not a K/C/O DM , HTN, epilepsy, TB .
Personal history:
Diet: mixed
Appetite: normal
Sleep: adequate
Bowel and bladder habits: regular
Addictions : no addictions
O/E:
Pt. is conscious, coherant, oriented to time , place , person.
Pallor present
No Icterus, cyanosis, clubbing , pedal edema.
Thin built.
Temp- Afebrile
Bp- 80/50mm of hg
PR- 80 bpm
RR-18 /min
Spo2-100
Grbs- 108 mg/dl
Systemic examination:
Cvs- s1 s2 present
Rs - NVBS present , no crepitations
P/A: soft, non- tender
Cns:
- Higher mental functions are intact.
- cranial nerves intact
- Motor system-
Tone: normal
Reflexes:
B T S K A P
Rt. - - - - withdrawal
Lt. - - - - withdrawal
Power: 4/5 upper limbs
4/5 lower limbs
Sensory system: normal
No signs of meningeal irritation.
PROVISIONAL DIAGNOSIS- ACUTE REPETITIVE SEIZURES
INVESTIGATIONS:
On 20/8/21:
Ophthalmology referral:
Treatment given:
On Day 1:
1. Inj. Levipil 500 mg IV BD
2. Inj pan 40 mg IV OD
3. Inj. Zofer 4 mg IV TID
4. Inj. Optineurin 1 amp in 100 ml NS IV OD
5. Inj. Loraz 2cc IV STAT
6. W/F seizure activity
7. Bp/pr /temp/spo2 monitoring
8. Strict I/O charting
Day 2:
1. Inj. Levipil 500 mg IV TID
2. Inj. Pantop 40 mg IV OD
3. Inj. Optineuron 1 amp in 100 ml NS /IV/ OD
4. Inj. Zofer 4 mg IV TID
5. Inj. Sodium valproate 1gm /IV stat in 100 ml NS F/B inj. Sodium valproate 200 mg in 100 ml NS /IV/BD
6. Watch for seizure activity
7. BP/PR/spo2/temp charting 4th hrly
8. Grbs charting 8th hrly
9. I/O charting
Day 3:
1. Watch for seizure activity
2. Monitor vitals
3. Grbs charting 8th hrly
4. I/O charting
5. IVF 1 NS with 1 amp Optineuron @ 75 ml/ hr
6. Inj. Pantop 40 mg /IV/OD
7. Inj. Zofer 4 mg /IV /TID
8. Inj Lorazepam /2cc /IV/sos
9. Tab. Orofer XT PO OD
10. Tab Lonazep 0.25 mg po BD
11. Tab. Lonazep MD 0.5 mg /sos(if pseudoseizure like activity)
Course in the hospital:
A 24 yr old female came to casuality with complaints of involuntary movements of bilateral upper and lower limbs since three days .Headache since 3 days. She was apparently asymptomatic 3 days back . on 17/08/21 , husband observed involuntary movements of bilateral upper and lower limbs GTCS type uprolling of eyes , frothing present . episode lasting for 5 to 10 min .
She was taken to nearby hospital and given Iv fluids .
After getting discharged and returning home she had a nother episode again she was taken to hospital and was given IV levipil1gm stat. On 19/9/21 she had another episode at home , she was brought to casuality and she ws given IV levipil 1 gm and 2 cc Loraz. On next day I.e .20/8/21 she had another episode and was given IV levipil, sodium valproate , lorazepam . eeg was taken and it was normal.psychiatry referral was taken . she had of episode of seizure on 21/08/21 and 22/08/21.Due to their personal reasons patient want to get discharge at request.
