17 yr old female with Involuntary movements.

This is online E-blog, to discuss our patient de-identified health data shared after taking her guardian's signed informed consent.

Here we discuss our individual patient problems through series of inputs from available global online community of experts with an aim to solve the patients clinical problem with current best evidence based input.

This E-blog also reflects my patient's centred online learning portfolio.

I have 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.
  
Our patient 17 yr old female born to consanginous parents studying 8th standard came to casuality  on 30/09/22 at 11Am with cheif complaints of involuntary movements of all 4 limbs associated with froathing from mouth & tongue bite present lasting for 4 mins of 2 episodes with post ictal confusion for 5 mins
On presentation to casuality, patient had one more episode of GTCS type of seizures for 1 min
Immediately patient was turned to left lateral position & INJ lorazepam 2cc IV /STAT given &regained consciousness after 5 mins.No further episodes were happened .
No h/o fever,headache,
No h/o trauma/fall
PAST HISTORY:
Not a k/c/o HTN,DM,EPILEPSY,THYROID 
No h/o similar complaints in the past 
MENSTRUAL HISTORY:
Menarche -13 yrs age
LMP- 25/08/2022
Cycle -5/30 , Irregular cycles.

GENERAL EXAMINATION:
Patient was in post ictal confusion state 
No pallor,cyanosis,clubbing, lymphadenopathy,Icterus.
Bp- 110/70
PR-118
RR-18
Spo2-100 %on room air.
GRBS-108g/dl
CVS- S1 S2+
CNS- NAD
R/S- BAE +
P/A-. Soft,non tender 
INVESTIGATION:-

MRI plain & contrast:
USG- ABD
2D- ECHO



PROVISIONAL DIAGNOSIS:-
NEW ONSET SEIZURES UNDER EVALUATION
TREATMENT:-
(1)INJ.LEVIPIL 1gm in 100 ml NS IV/ STAT
                   500 mg IV/BD
(2)INJ.LORAZEPAM 2cc IV/SOS
(3)IVF- NS @ 50 ml/hr
(4)INJ.PAN 40 mg /IV/OD
(5)INJ.ZOFER 4 mg/ IV/SOS

SOAP NOTES:-
17 yr old female admitted on 30/09/22

Day 2

S:
No episode of involuntary movements.
Vomitings subsided.

O:
Pt is c/c/c

BP: 90/60mmhg
PR:80m
CVS- S1,S2 heard
RS- BAE+ ,Reduced breath sounds in Right infra axillary & Left infra scapular Area.
P/A soft, non tender.
CNS- NAD ,GCS -E4V5M6
GRBS- 88mg/dl
Temp- 98.4f

A:
NEW ONSET SEIZURES secondary to NCC stage 3, TUBERCULOMA.

P:
INJ.LEVIPIL 500 mg /IV/BD
INJ.LORAZEPAM 2 cc/IV/SOS
IVF.NS @50 ml/hr
INJ.ZOFER 4 mg/IV/SOS
INJ.DEXA 6mg/IV/TID
TAB.AlBENDAZOLE 300 mg /po/BD


Day 3

S:
No episode of involuntary movements.
Vomitings subsided.

O:
Pt is c/c/c

BP: 90/60mmhg
PR:80m
CVS- S1,S2 heard
RS- BAE+ ,Reduced breath sounds in Right infra axillary & Left infra scapular Area.
P/A soft, non tender.
CNS- NAD ,GCS -E4V5M6
GRBS- 88mg/dl
Temp- 98.4f

A:
NEW ONSET SEIZURES secondary to NCC stage 3, TUBERCULOMA.

P:
INJ.LEVIPIL 500 mg /IV/BD
INJ.LORAZEPAM 2 cc/IV/SOS
IVF.NS @50 ml/hr
INJ.ZOFER 4 mg/IV/SOS
INJ.DEXA 6mg/IV/TID
TAB.AlBENDAZOLE 300 mg /po/BD

# APPROACH TO SEIZURES:-
Reference image from harrison's textbook Of Internal Medicine.
https://images.app.goo.gl/CKLrQNDoFLfdVYTr7
In our patient ,
(1)ON CNS Examination  - No focal neurological deficits found.
(2)According to the above picture...
We ruled out the metabolic causes.
(3)Then we go with the MRI scan which gave impression as
Ring enhancing lesion in the right frontal lobe with perilesional edema.
Then we diagnosed the patient as NEUROCYSTICERCOSIS stage 3.

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