SEIZURES SECONDARY TO ACUTE INFRACTS IN FRONTAL AND LT TEMPORAL LOBEACUTE INFARCT IN FRONTAL AND LEFT TEMPORAL LOBESHIO PULMONARY KOCHS (taken completemedicine course )HIO ECLAMPSIA ( 38 yrs ago"

 A 50 yr old female brought to medical opd with cheif complaints of slurring of speech since yesterday

morning, seizure like activity since yesterday morning

Pt was apparently asymptomatic 38 yrs back, then during her second pregnancy , developed an

episode of seizures ( tonic seizures ; for 10 mins following which no weakness or slurring of speech.

No scanning was done . Post delivery was uneventful

Pt has frequent similar episodes of approx 10 / year and on irregular medication l episodes increase

in number during emotional distress / abstinence of food intake

8 yrs back, pt had similar episode following which h/o fall, sustained head injury ( for which she had

8-10 stiches ) - scanning done -_? Clot in brain ( lt parietal ), had loss of speech , loss of memory (

regained slowly after a month ), no weakness of woper and lower limbs, no deviation of mouth, no

vomiting, loc present for 2 mins , no bladder/bowel incontinence

Staryted on medication s ( on unknown medications for 4-5 months ). she slowly regained her speech

2 months later

1 year back , she had similar episode of loss of speech and memory loss ? Altered sensorium 7

Inabilitv to identity family members . o seizure like actilvity -_ Got investigated brain imaging done

showing ? Old infarct ( reports unavailable)

1 day back, decreased consumption of food, sudden onset of ? Altered sensorium, decreased

speech, seizure like activity, tonic type for 10 mins - no tongue bite, no bowel &bladder incontinence.

post ictal confusion + for 15 mins, no weakness of upperlimb and lowerlimb and was taken to outside

hospital ad was given some unknown medication s &was told she had tow BP -following which pt

improved

Again pt had similar episode in morning, pt was unresponsive and episode of 1 tonic seizure and was

brought to our hospital

MEDICAL HISTORY:

Known case of TB ( PULM KOCHS ) used ATT FOR A COMPLETE 6 MONTHS PERIOD

FOLLOWING WHICH CBNAAT CAME NEGATIVE : SHE STOPPED USING MEDICATIONS 1

MONTN BACKNot a KICIO HTN' DM asthma / lschemic heart disease / epilepsySURGICAL

HISTORY: PT UNDERWENT HISTERECTOMY 10 YRS BACK; FOR ? FIBROIDFAMILY

HISTORYNo significant family historyPERSONAL HISTORYOCCUPATION: FarmerDIET;

MixedAPPETITE : NormaISLEEP : NormaBOWEL AND BLADDER HABITS : NormalADDICTIONS:

Occasional drinker ; completely stopped 8 yrs backGENERAL EXAMINATION* Patient is concious

coherent and cooperative' Built - moderately built , moderately nourishedVITALSBlood pressure*

130/90 mm hgPulse Rate: 100 bpmTemperature: 98.6 degrees FSPO2: 98 @ RAGRBS: 120

mo/dPALLOR:PRESENT'NO ICTERUS, CYANOSIS, CLUBBING

LYMPHADENOPATHYSYSTEMIC EXAMINATION.:CVS e S2 heard no added soundsRS BAE

+. NVBSPA- soft , NT , BS +CNS - at the time of admission -Tongue deviation : +Mouth deviation

+Rhombergs : +Power - UL : t - 5/5 , |t- 5/5 LL : t - 5/5 , 1t- 5/5Tone -UL :rt-N,lt-NLL:n-N,lt

. NReflexes - B T S K A plantar Rt: + + + + + flexion Lt: 44 4tt + +4 + flexionOn 2/1/23 .Tongue

deviation : -Mouh deviation : -Rhombergs : -Power - UL : rt- 5/5, |t- 5/5 LL : rt- 5/5, | - 5/5Tone

UL:r-N.|-NLL :/t-N, lt- NReflexes - BT S K Aplantar Rt:+ + + + ++ flexion Lt: tt +++ ++

++ flexionCOURSE IN THE HOSPITAL :PT ADMITTED WITH ABOVE MENTIONED COMPLAINTS

INVESTIGATED AND EVALUATED FOR CVAPT IS HAEMODYNAMICALLY STABLE AND

DISCHARGEDCNS FINDING:MRI: MULTIPLE INFSRTCTS IN FRONTAL AND TEMPORAL

LOBESPSYCHIATRY REFERRAL IN VIEW OF BEHAVIORAL CHANGES WAS TAKEN AND

ADVISE FOLLOWED

Investigation

MRI BRAIN PLAIN:

ACUTE INFARCT IN FRONTAI AND LT TEMPORAL LOBE - MCA TERRITORY

NO HEMORRHAGE

2D ECHO

EF :61 %

RUSP: 35 MM HG

CONCLUSION- TRIVIAL TR+, AR+, NO MR

NO RWMA. NO AS/MS

GOOD LV SYSTOLIC FUNCTION

DIASTOLIC DYSFUNCTION +. NO PAHPE

DIAGNOSIS 

SEIZURES SECONDARY TO ACUTE INFRACTS IN FRONTAL AND LT TEMPORAL LOBEACUTE INFARCT IN FRONTAL AND LEFT TEMPORAL LOBESHIO PULMONARY KOCHS (taken completemedicine course )HIO ECLAMPSIA ( 38 yrs ago)

Treatment Given(Enter only Generic Name)

TAB. LEVIPIL 500MG POBD

TAB. ECOSPIRIN 75 MG PO/OD

TAB. CLOPITAB 150 MG PO/OD

TAB. ATORVAS 75 MG PO/HS

Advice at Discharge

TAB. LEVIPIL 500MG PO/BD FOR 1 MONTH

TAB. ECOSPIRIN 75 MG PO/ODFOR 1 MONTH

TAB. CLOPITAB 150 MG PO/ODFOR 1 MONTH

TAB. ATORVAS 75 MG PO/HSFOR 1 MONTH