27 yr old with htn and seizures

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Chief complaints:-

This is a case of 27 yr old male from mothukuru who is ddriver by occupation brought to casuality by his attenders with chief complaints of involuntary movements of b/l UL since 2 hours

Patient was born and broughtup by his parents in mothukuru,he was a healthy with no health issues studied till 10th standard,afher his father demise he stopped studying and started as driver (jcb).

1 year ago patient had neck pain lasting for 2 days associated with mild headache for which he went to local hospital and found to have high blood pressure,he used medication for relief of neck pain but not started on anti hypertensives,

Till 12/5/24 he remained asympttomatic,on this day he woke up around 6:30 am attended nature calls and after 30-40 minutes he satrted having headache more in frontal region for which he drank tea to get relived from headache and slept 

After 30-40 minutes his mother noticed the pt is having involuntary movements of rt UL followed by b/l UL with uprolling of eyes lasting for 3-4 minutes,he was unaware of surroundings,no h/o tongue bite,involuntary passage of stools and urine,no h/o  fever no h/o trauma to head, immediately pt was shifted to local hospital where he was found to have high blood pressure around 220/100 mm hg,they administered medication to lower the bp and referred him to higher center,on th way pt had similar episoded 3 times lasting for 3-4 minutes.

Past history:- no similar complaints in past 

Known htn nce 1 yr not using medication 

Family history :-

Elder sister is hypertensive (diagnosed during her 2nd pregnancy)

Found to have single kidney (incodental finding during first peegnancy,Had 2 abortions)

Patient is on mixed diet

Normal apettite

Adequate sleep

Regular bowel and bladder movements 

Addictions:- started consuming alcohol in 2006 due to peer pressure 

Consumes90-180 ml whisky 10-12 times a month 

Last consumption-26/4/24

Consumes ambar(tobacco)daily

Daily routine:- 6:30 am- wake up

7-7:30 am- breakfast 

8 am - attends work 

2pm - lunch

2pm-9pm- work

9:30 pm dinner

11pm-sleep

General examination:-

Patient was moderatley built and nourished 

No pallor,icterus,cyanosis,clubbing,koilonychia,edema

Vitals:-at presentation

Bp:-90/60 mmhg

PR:-94 bpm

Rr:-16 cpm

Spo2:-94 on RA

Temp :Afebrile 

Grbs:- 105 mg/dl

Systemic examination :-

Cns pt is confused and irritable 

Gcs:-E4V5M6

Tone:- normla in all limbs

Power:5/5 in all limbs 

Reflexes:

      Rt       lt

B.   3+.      3+

T.  2+.        2+

S.   ,+.          +

K     2+.         2+

A.     +.        +

P  flex       flex

Provisional diagnosis:- ?focal seizuresz ,k/,c/o htn 

Investigations

ecg on 13/5/24

Ecg on 14/5/24

ophthalmology referral was taken i/v/o Htn retinopathy changes:

Report:- B/L normal fundus study

No htn retinopathy changes

Hemogram on 

12/5/24:-    14/5

Hb:16.9.    -14.4

TLC 29,900-10,800

Plt:3.8       -2.5

On 13/5/24

Rbs:-115mg/dl

Serology negative 

Cue:-

Alb +

Sugars nil

Rbc nil

Pus cells -3-4

Epi-2-3

Lft

Tb:-2.66

Db:-0.46

Sgot:-36

Sgpt:-48

Alp:-136

Tp:-6.5

Alb:-4.26

A/G:-1.90

Final diagnosis:-Focal to b/l tonic clonic seizures secondary to young onset stroke

?NCC

K/c/o HTn

Treatment given:-

Inj.Thiamine 200 mg iv/bd in 100 ml NS

Inj.levipil 500mg iv/od

Tab.Ecosprin 150 mg po/od

Tab.Clopitab 75 mg po/od

Tab.Atorvas 40 mg po,/hs

Tab.Telma 20 mg po/od

Monitor vitals  watch for seizure