45 year old male with c/o seizures

















 DR. YAMINI ( INTERN)

DR. AMULYA ( INTERN) 

DR. SURYA PRADEEP ( INTERN)

DR. ASHA KIRAN ( INTERN)
DR. JAYANTH ( INTERN) 
DR. VAMSHI ( INTERN)
DR. ISMAIL ( INTERN ) 
DR. PRADEEP ( PG 1st YEAR)
DR. NIKITHA (PG 2nd YEAR)
DR. SUFIYA ( PG 3rd YEAR) 
DR. SATISH ( PG 3rd YEAR)
Faculty : DR. VIJAYALAXMI

This  is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. 


Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. 

This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box is welcome. Here is a case i have seen: 



45 yrs male came to casualty with c/o giddiness since 2 hrs
seizures since evening (1 episode)
at 4:30 pm pt was one of the pillion driver on bike, suddenly he had sensation of dizziness, following which he had loss of consciousness and about to fall, he was caught by his friend in the back. made him lie down.
no involuntary movements of upper limb and lower limb
tongue bite +
no involuntary micturation and defecation. he regained consciousness with in 10 min and became fully oriented after 30 min.
pt had similar episode 10 yrs back 2 episodes 1 month apart lost consciousness for 10 min became fully oriented with in 10 min. no seizure episode from these 10 yrs.
K/C/O HTN SINCE 2 YRS ON MEDICATION - TELMISARTAN 40 MG 
K/C/O  SEIZURES (1 EPISODE 10 YRS BACK USED MEDICATION FOR 2 YRS and stopped.)
Not a K/C/O DM2/ASTHMA/CAD/CVA
chronic smoker 20 beedis /day(since 30 yrs)
chronic alcoholic 90 ml/day (since 10 yrs)

ON EXAMINATION: 
PT IS C/C/C
No signs of pallor, icterus, cyanosis, pedal edema 
Clubbing of fingers present - parrot beaking




TEMP: AFEBRILE
BP:140/80 MM HG
PR:109 BPM
RR: 21CPM
SPO2 :94% @ ROOM AIR
GRBS:127 MG/DL
SYSTEMIC EXAMINATION:
CVS: S1,S2 + ,NO ADDED SOUNDS
R/S : BAE +
CNS: NO FOCAL DEFICIT
P/A : SOFT,NON TENDER
 
INVESTIGATIONS: 

Haemogram: 
Rft and lft: 
ECG: 
Chest X-ray: 


PROVISIONAL DIAGNOSIS: 

SEIZURES UNDER EVALUATION 
POLYCYTHEMIA K/C/O HTN 

TREATMENT:
1. Inj. THIAMINE 100mg in 100ml NS * IV/ TID 
2. Tab. LEVIPIL 500mg/ BD/ PO 
3. Tab. TELMISARTAN 40mg/ OD 
4. Inj. LORAZEPAM 2 cc/ SOS 


Day-1 (17/02/2021) 
S- c/o low back ache 
O- pt is c/c 
BP- 140/80mmhg 
PR- 84bpm 
RR- 18cpm 
CVS- S1S2 heard 
RS- BAE+ 
CNS- no focal deficits 
P/A- soft non tender 

A- seizures under evaluation 
POLYCYTHEMIA 
K/C/O HTN 
P- 
1. Inj. THIAMINE 100mg in 100ml NS * 2
2. Tab. LEVIPIL 500mg/ BD/ PO 
3. Tab. TELMISARTAN 40mg/ OD 
4. Inj. LORAZEPAM 2 cc/ SOS 
5. Tab. PHENYTOIN 

Haemogram- 

MRI brain : 

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