28 yr old male mutton butcher by occupation came with c/o 3 episodes of seizures in one day
A 28 yr old mutton butcher by occupation came to casualty with complaints of seizures 3 episodes in one day .
Patient was apparently asymptomatic 1 day ago and then he suddenly developed seizures in the morning at 10am when he went to work . Then he was brought to home Second episode while he woke up from the sleep at 2pm .
Third episode when he went to bring curd from the market he got seizures and he fell down on a stone and injured his parietal region of scalp and facial asymmetry .loss of consciousness regained consciousness after 30 mins in each episode.
H/O post ictal confusion present
h/o tongue bite .
No h/o frothing .
The laceration of length 4cm x 1cm was sutured at an outside hospital .
Swelling over the left cheek measuring 3cm x 2cm , Tenderness
Past history :
Patient consumed mono poisoning 11/2 yr ago and got intubated in our hospital .
He consumed mono due to family issues and conflicts with his mother.
1yr ago he fell from bike and sustained minor injuries and lesions on tongue.
H/O similar seizures episodes in the past ( one episode -8 months ago and another episode - 6 months ago for which he didn’t get treated as the attenders thought it is not a seizures episode.)
No h/o DM, HTN, CAD , CVA , TB, BA .
H/o consumption of alcohol since 5yrs .He started taking alcohol to get relief from
stress and at frst he used to consume 90ml occasionally.later he started consuming 120 ml/ day regularly. Last binge 90 ml yesterday morning .
H/o consumption of gutka 2yrs ago for 1yr when he did job in Hyderabad. He stopped chewing gutka after he got married.
On examination
Vitals :
Temp :Afebrile
Pr: 76bpm
Bp:120/80 mm hg
RR : 16 cpm
Systemic examination:
Cvs : S1S2 heard
Cns:
Reflexes Rt. Lt
Biceps :
Triceps:
Supinator: .
Knee: .
Ankle : — —
Inspection: laceration of length 4cm x 1cm over parietal region
Swelling measuring 3cm x 2cm over left zygoma region .
On palpation of swelling tenderness
Vestibular tenderness in the left zygomatic region.
RS: BAE
P/A : Soft , Non tender
Habits :
Sleep : inadequate
Bowel & bladder: regular
Appetite : decreased , Non vegeterian
Investigations:
CT BRAIN
CHEST X-RAY
Provisional diagnosis: SEIZURE DISORDER secondary to ? Alcohol withdrawal ? Alcoholic hepatitis with laceration over scalp
Treatment :
INJ THIAMINE 200mg in 100ml NS IV /TID
INJ LEVIPIL 500mg IV /BD
INJ LORAZEPAM 2cc/IV /SOS
INJ MONOCEF 1gr /IV /BD
INJ PAN 40MG IV /OD
