A 50 YR F WITH SEIZURES UNDER EVALUATION WITH CVA WITH ACUTE INFARCTS IN FRONTAL AND LT TEMPORAL LOBES
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Hyndavi Konakanchi, Intern
23/12/22
A CASE DISCUSSION 50/F WITH SEIZURES UNDER EVALUATION ? CVA
I've been given this case to solve in an attempt to understand the topic of "patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with a diagnosis and treatment plan.
Following is the view of my case :
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 ( 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 medications ( 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 ? Behavioural changes? Inability to identify family members , no seizure like activity — Got investigated brain imaging done showing ? Old infarct ( reports unavailable)
1 day back, decreased consumption of food , sudden onset of ? Behavioural changes ,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 and was given some unknown medications & was told she had low 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 BACK
DIET : Mixed
APPETITE : Normal
SLEEP : Normal
BOWEL AND BLADDER HABITS : Normal
ADDICTIONS: Occasional drinker ; completely stopped 8 yrs back
GENERAL EXAMINATION
* Patient is concious coherent and cooperative
VITALS
Blood pressure : 130/90 mm hg
Pulse Rate : 100 bpm
Temperature : 98.6 degrees F
SPO2 : 98 @ RA
GRBS : 120 mg/dl
* NO ICTERUS , CYANOSIS, CLUBBING , LYMPHADENOPATHY
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