A 36 year old male presented to opd with seizures.
History of present illness: On 24th a 36 years old male patient cable operator by occupation presented to general medicine opd with seizures at 3am. The patient was apparently asymptomatic until 2am then he developed seizures which occurred in 4 episodes with an interval of 5-10 minutes, each episode lasting for 2 minutes, without postictal confusion. The seizures were generalized and with vigorous contractions and relaxations. Just before the occurrence of 1st episode patient experienced tightening of muscles in the limbs and lifting of the lower limbs.
3 years back he was diagnosed with diabetes type 2 and is on medication. When RBS was done immediately after he came to hospital it was 559 and the BP was 160/100 mm Hg.
Past history: No similar complains in the past. In 2019 there was mild head trauma and swelling which subsided after 3 days.
Not a known case of Hypertension, Asthma, thyroid, epilepsy.
Personal history: Patient is a cable operator by occupation. He wakes up by 9 am and goes to his job, takes lunch by 2pm and comes home after the work is done sometimes takes rice for dinner . His appetite is normal, sleep is adequate,bowel and bladder are regular, and he occasionally consumes alcohol. The day before the patient had seizures he consumed 180ml of wine and fruits (apple and Pomegranate).
Family history: Patient's father is a known case of diabetes and Hypertension. No similar complains in the family.
Drug history: k/c/o diabetes, and is on medication metformin 500mg +glimipiride 1mg since 3 years.
General examination:
Pallor: absent
Icterus :absent
Cyanosis: absent
Clubbing:absent
Lymphadenopathy: absent
Edema: absent
BP:
Temperature:afebrile
Respiratory rate: 16cpm
Heart rate:78bpm
Systemic examination:
CNS:
1. HIGHER MENTAL FUNCTIONS:
Conscious, coherent and Cooperative
Appearance and behaviour:
Emotionally stable
Recent, immediate ,remote memory intact
Speech : comprehension normal, fluency normal ,No repeatitions .
Right handed individual .
2. CRANIAL NERVE EXAMINATION:
*Olfactory: Normal
*Optic nerve : visual acuity : CF
Pupil: sluggish pupillary response to light
*3,4,6 : normal , ocular motility is present in all directions.
*Trigeminal : normal sensory and motor
* Facial nerve : forehead wrinkling present
Able to close eyes, able to blow cheeks.
* 8th nerve : decreased hearing.
* 9 and 10 nerves: normal
*11th nerve : SCM, trapezius : normal.
*12 th nerve : no deviation of tongue, no fasiculations.
MOTOR EXAMINATION :
Bulk: normal
Tone : Right Left
Upper limb Normal Normal
Lower limb
Power: Right Left
Upper limb 4/5 4/5
Lower limb 4/5 4/5
Reflexes : Right Left
Corneal present present
Conjunctival present present
Deep reflexes
Biceps + +
Triceps + +
Knee + +
Ankle + +
SENSORY FUNCTIONS
SPINOTHALAMIC TRACT
Pain, temperature, pressure- intact in all limbs
Posterior column :
Fine touch,vibration, proprioception are intact
CEREBELLAR FUNCTIONS :
Titubation: absent
Nystagmus : absent
Dysmetria : absent
Dysdiadochokinesia : absent
Intension tremor : absent
No signs of cerebellar dysfunction.
CVS : S1 S2 ++ no murmurs heard.
RESPIRATORY SYSTEM: Normal vesicular breath sounds heard.
ABDOMEN: Soft non tender.
Investigations:
MRI:
Bilateral symmetrical periventricular hyperintensities- Chronic small vessel ischemia.
Fundus examination:
Provisional diagnosis: Hyperglycemia induced seizures with microvessel thrombi due to Hypertension and diabetes.
Treatment:
Inj HAI 1ml 40units +39ml NS
Inj Thiamine 200mg in 100ml NS IV TID
Inj Zofer 4mgIV SOS
Inj pan40mg IV OD
Tab Ecospirin 75mg PO OD
Tab atorvas 20mg PO OD .
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