GENERALIZED TONIC CLONIC SEIZURES SECONDARY TO VIRAL ENCEPHALITIS ,HYPOKALEMIA,HYPOPROTEINEMIA,DIABETIC NEPHROPATHY AND DIABETIC RETINOPATHY
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Complaints of seizure from yesterday
Patient was apparently asymptomatic 6 days back then he developed fever for 2 days)which was low grade ,intermittent and associated with chills and relieved on medication.
On 2nd day of fever i.e on sunday he had headache which was severe in intensity and associated with blurring of vision and diplopia.
On monday night 11 pm he developed involuntary movements of upper and lower limb and associated with tongue bite and was unconsciouS
While in ambulance he had similar 2 episodes which were for 5min each within 30 min and was unconscious.
Patient was taken to private hospital were he had 3 episodes of seizures happened till next day morning and was advised CT Brain.
Then patient was taken to government hospital where CT Brain was done which showed chronic lacunar infarcts in lentifrom nucleus
He had 7 episodes of seizures within 2 days but was conscious between the episodes and was referred to our hospital
At the time of admission
He had 3 episodes of seizures ,patient became stiff ,there was tongue bite and uprolling of eyeballs
No loss of consciousness,no urinary or bowel incontinece,no vomiting or headache after the episodes
No h/o vomitings ,head injury, ear discharge,neck stiffness,photophobia
K/c/o DM since 15 yrs and on TAB.METFORMIN 500MG and TAB GLIMIPIRIDE 1 MG
K/c/o HTN since 3 yrs and on medication TAB.ATENOLOL 50MG
Alcohol occasionally
somker [stopped 20yrs back]
K/c/o HTN since 3 yrs and on medication TAB.ATENOLOL 50MG
Alcohol occasionally
somker [stopped 20yrs back]
O/E
pt is conscious coherent cooperative
GCS-15/15
Temp-afebrile
PR-79bpm
BP-130/90 mmHg
spo2-97%at room air
GRBS-335 mg/dl
Temp-afebrile
PR-79bpm
BP-130/90 mmHg
spo2-97%at room air
GRBS-335 mg/dl
Systemic Examination
cvs-s1,s2+
Rs-BAE+
p/A-soft non tender
CNS
Higher Mental functions-Normal
Cranial nerves-NAD
motor system-. R. L.
power UL-. 5/5. 5/5.
LL-. 4/5. 4/5.
Tone-. UL-. normal normal
LL-. normal normal
reflexes-. R. L.
biceps-. 1+. 1+
triceps-. 1+ 1+
supinator-. 1+ 1+
knee. 1+ 1+
ankle-. 1+ 1+
plantar - flexion flexion
SENSORY SYSTEM
Spinothalamic- intact
Dorsal column - intact
Cortical sensations -intact
CEREBRLLAR FUNCTION TEST
Finger nose test-normal
Knee heel test-normal
Dysdiadokokinesia-normal
Gait
PROVISIONAL DIAGNOSIS-GENERALIZED TONIC CLONIC SEIZURES SECONDARY TO VIRAL ENCEPHALITIS
1) Inj LEVIPIL 1000mg/IV/STAT
2)INJ PHENYTOIN 900mg/6 amp in 100 ml NS over 30 min
3)IVF 1NS AND 1 RL @100ML/HR
4)INJ LORAZEPAM 4CC/IV/SOS
5)INJ MONOCEF 1gm/IV/BD
6)INJ PAN 40 MG/IV/OD
7)INJ OPTINEURON 1amp IN 100 ML NS/OD
PATIENT HAD NO SEIZURE EPISODE
C/O HEADACHE SINCE MORNING
OC/O FEVER SINCE MRNG
VITALS
TEMP-AFEBRILE
BP-130/80MM HG
PR-78BPM
SERUM POTTASIUM -2.7
TREATMENT
1)Inj LEVIPIL 500mg/IV/BD
2)INJ LORAZEPAM 4CC/IV/SOS
3)INJ MONOCEF 1gm/IV/BD
4)INJ PAN 40 MG/IV/OD
5)INJ OPTINEURON 1amp IN 100 ML NS/IV/OD
6)TAB ASPIRIN 75MG/PO/OD
7)TAB ATORVAS 40MG/PO/OD
8)TAB ULTRACET /PO/BD
9)SYP POTCHLOR 15ML/PO/TID
NO EPISODE OF SEIZURE
HEADACHE SLIGHTLY DECREASED
SERUM POTASSIUM-2.8
1)Inj LEVIPIL 500mg/IV/BD
2)INJ LORAZEPAM 4CC/IV/SOS
3)INJ MONOCEF 1gm/IV/BD
4)INJ PAN 40 MG/IV/OD
5)INJ OPTINEURON 1amp IN 100 ML NS/IV/OD
6)TAB ASPIRIN 75MG/PO/OD
7)TAB ATORVAS 40MG/PO/OD
8)TAB ULTRACET /PO/BD
9)SYP POTCHLOR 15ML/PO/TID
DIAGNOSIS-
GENERALIZED TONIC CLONIC SEIZURES SECONDARY TO VIRAL ENCEPHALITIS ,HYPOKALEMIA,HYPOPROTEINEMIA,DIABETIC NEPHROPATHY AND DIABETIC RETINOPATHY
