A 55 yrs old male came to casuality with seizure activity

11-03-2022

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55 year old male who is a farmer came to casuality with alleged history of seizure activity on 28/2/22 for which he was admitted in a hospital where he was resuscitated and intubated after having cardiac arrest on day 2 (4 am) of his stay at the hospital.

HISTORY OF PRESENTING ILLNESS : 

Patient was apparently asymptomatic 6 years back then he suffered with sudden onset seizure activity which lasted for 8- 10 minutes ON 28/2/2022 . 

He had h/o involuntary movements of upper limb and lower limb with uprolling of eyes along with aura ,involuntary micturition and defecation, tongue bite, post ictal confusion.

He was rushed to a nearby hospital and was treated conservatively .During the stay in the hospital patient had cardiac arrest on day 2 of admission at 4 a.m. was intubated and put on mechanical ventilator and referred to us in view of of their affordability issues. 

History of fever since 3 days.

PAST HISTORY:

k/c/o seizures since 6 years.

History of trauma to head 10 years back (fall from bike ) ,no chief complaints of LOC, headache, seizures giddiness.

H/o seizure attack 6 years back for which he was treated with levipril.

1 year back he had another seizure activity since then he was advised to take regular medication ( levipil) to avoid future seizure activity but the patient didn't take regular medication.

Not a known case of DM and HTN. 

PERSONAL HISTORY: 

Alcoholic since 15 years , tobacco smoking since 30 years

GENERAL EXAMINATION:

O/E : patient is on mechanical ventilator

         FiO2 - 40%

          PEEP- 5

           VT - 420

          GCS: E1 VT M2

Pallor - present

Icterus absent

Cyanosis - absent

Edema of feet - present

Lymphadenopathy - absent

Clubbing - absent

VITALS:

Temperature: 100 F

 BP: 140/80mmhg 

  PR: 112 bpm 

  RR : 18CPM

   SYSTEMIC EXAMINATION:       

CNS:

Pupils - B/L NSRL

Reflexes:            

      Biceps 2+ 2+

      Triceps 2+ 2+

      Supinator 2+ 2+

      Knee 3+ 3+

      Ankle - -

      Plantar flexion flexion

CARDIOVASCULAR SYSTEM : S1 and S2 heard, no murmurs heard 

RESPIRATORY SYSTEM : BAE present

P/A : soft

INVESTIGATIONS:

5/3/22

BGT: B POSITIVE

PROVISIONAL DIAGNOSIS:

 SEIZURE UNDER EVALUATION (? ALCOHOL WITHDRAWAL SEIZURE) ? HYPOXIC ENCEPHALOPATHY POST CPR STATUS DAY 5 

TREATMENT: 

HEAD AND ELEVATION UP TO 30%

INJ. MEROPENEM 1 G IV BD

 INJ. LEVIPIL 500 MG IV BD 

INJ MIDAZOLAM 10 MG IN 50 ML NS @ 30 ML/ hr INJ. MANNITOL 100 ML IV BD

INJ. PANTOP 40 MG IV OD

INJ. NEOMOL 100 ML IF TEMPERATURE > 101 F INJ THIAMINE 2 AMP IN ONE DNS IV BD