21 yr old female with involuntary movements

 A 21 years old female P2L2 delivered 10 days back NVD - live male baby of 3.5kgs, housewife by occupation brought with complaints of 

  • Headache since Morning 
  • 1 episode of involuntary movements at 12am

HOPI:

Patient was apparently asymptomatic 1 day back then complained of headache since morning, 1 episode of involuntary movements pattern of tonic clonic seizure at around 12am today

H/o frothing from mouth 

No H/o tongue bite

No h/o involuntary micturition and defecation 

Episode lasted for 2 mins

Post ictal confusion present.


PAST HISTORY: Not a k/c/o DM,htn,tb,asthma,epilepsy 

PERSONAL HISTORY:

She is Married
She consumes 
  • Mixed diet 
  • sleep is adequate 
  • Appetite normal
  • bowel and bladder movements are regular

MENSTRUAL HISTORY: 

Age at menarche:12 years

Cycle: 30/5 days, Normal flow.

OBSTETRIC HISTORY:

Age at Marriage:19 years

1st pregnancy: conceived after 1 month  of pregnancy,NVD, 

2nd pregnancy: conceived after 6 months of 1st pregnancy NVD.

FAMILY HISTORY:

No similar complaints in family 

CLINICAL IMAGES:



General examination:

On presentation: Patient conscious, coherent, cooperative, well oriented to time place and person.

Pallor present 

Vitals:

Bp:120/80

Pr:130bpm

Rr:24cpm

Temp:98.2f

Grbs:84mg/dl

Spo2:97%

SYSTEMIC EXAMINATION:

CVS:s1,s2 +

Rs:bae+

P/a: size of uterus:corresponding to 12wks 

CNS: b/l pupils NSRL

              R         L

Tone:    N.        N

Power:  5/5.     5/5                  

Reflexes : B    T  S   A   K    P 

           R:    +    +  +   +    +   Flexion 

           L :    +   +   +   +    +  Flexion

No neck stiffness 

Kernigs negetive 

Brudzinski negetive 

INVESTIGATIONS:


















DIAGNOSIS : Seizures under evaluation.

TREATMENT:

Presently: had a 2nd of episode of involuntary movement pattern of tonic clonic seizure at 1:15am lasted for 2 mins 

H/o frothing from mouth

No h/o tongue bite

No h/o involuntary micturition and defecation 

Post ictal confusion present.

Plan at the time of episode: 

2mg lorazepam IV

Levipill 25mg in 100ml NS IV

25 D IV

2D ECHO: https://youtu.be/wZAYPcDaEGE

Day 2:

S: No fresh Complaints 

O:

Pt conscious,coherent,cooperative, well oriented to time place and person.

Pallor Present

Vitals:

Bp:110/80

Pr:90bpm

Rr:20cpm

Temp:99.2f

Grbs:96mg/dl

Spo2:97%

SYSTEMIC EXAMINATION:

CVS:s1,s2 +

Rs:bae+

P/a: size of uterus:corresponding to 12wks 

CNS: NAD

A: SEIZURE UNDER EVALUATION 

P: 
Plan for EEG 
1.Tab.levipil 500mg po/od
2.Tab.Dolo 650mg po/sos
3.Tab.zincovit po/od

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