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
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
