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A 30 yr old male who is a student resident of suryapet came to general medicine OPD with chief complaints of involuntary stiffening of left upper and lower limbs sence 18 yrs.
HISTORY OF PRESENTING ILLNESS:
Patient was apparently asymptomatic 18 yrs back then he started developing involuntary movements and stiffening of left upper and lower limbs associated with up rolling of eyes,froathing, headache,loss of language,fear, anxiety, apnea,stertoreus breathing,vocalization during episode and loss of balance .
Not associated with involuntary micturition, defecation and tongue biting
Episodes:2-3 per month
History of triggering of seizure activity by stress.history of decreased hearing in the left ear associated with tinnitus .
Drug history:
patient is on tablet.carbamazapine 200mg po/BD but the seizure activity is not subsiding.
PAST HISTORY:
N/k/c/o thyroid disorder,CVA,CAD,Asthma,TB,HTN
Diabetes
FAMILY HISTORY:
No history of seizure disorder in the family
PERSONAL HISTORY:
Diet :mixed
Appetite:normal
Sleep: adequate
Bowel and bladder movements:regular
No addictions
No known allergies
GENERAL EXAMINATION:
Patient is conscious coherent and cooperative well oriented to time and place
No pallor
No icterus
No cyanosis
No clubbing
No pedal edema
No lymphaadenopathy
Vitals:
Temperature:afebrile
BP:120/70 mmHg
RR:11cpm
PR:88/min
SYSTEMIC EXAMINATION:
CVS:
S1,S2 present,no thrills ,no murmurs
RESPIRATORY SYSTEM:
position of trachea central
No history of dyspnea and wheeze
Normal vesicular breath sounds are heard
PER ABDOMEN:
Shape of the abdomen:scaphoid
No tenderness
No palpable masses
No hepatosplenomegaly
CNS:
speech:normal
Gait:normal
No signs of meningitis
Glasgow scale:G4V5M6
Cerebellar signs -
Finger nose test-coordinated
Knee-heek test-coordinated
Dysdiadokinesia-positive
Nystagmus-absent
PROVISIONAL DIAGNOSIS:
Seizures-GTCS???
INVESTIGATIONS:
HEMOGRAM:
HB-15.6
TLC-5,700
PCV-44.7
PLATELET COUNT:2.1 LAKH
COMPLETE URINE EXAMINATION:
Albumin-trace
Sugar-nil
Bile salts-nil
Bile pigments-nil
RFT:
urea-23
Creatinine-1.0
Uric acid-3.8
Calcium -10.0
Na+ -144
K+ -4.1
Cl- -106
LFT:
Total bilirubin:0.56
Direct bilirubin:0.18
SGOT-21
SGPT-13
ALP-163
TP-7.9
RBS-100mg/dl
ECG:
TREATMENT:
Tab.carbamazapine-200mg po/tid
Tab.MVT-po/od
Watchful for seizure activity
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