A CASE OF PRIMIGRAVIDA WITH SEIZURES UNDER EVALUATION
22 yr old primi with 10wks+1day of GA brought to casuality with C/o 1 episode of muscle spasms ?seizure like activity since 1 hr
H/o recurrent febrile seizures since childhood
3 yrs ago patient had h/o fever with seizures, pt was started on antiepileptics - TAB LEVIPIL 500mg, TAB CLOBAZAM 5mg
H/o fever 5 days ago
Pt missed her 1 dose of antiepileptics and then she had 1 episode of seizures with clenching of fists, frothing
MRI BRAIN done outside then showed enlarged pituitary gland, venogram - Normal
Hypocalcemia + (ca 8.0)
Serum Electrolytes - Normal
Pt was started on INJ LEVIPIL 500mg BD —>TAB LEVIPIL 500mg BD
- No H/o episodes of seizures since 2 years
Yesterday evening pt had a episode of muscle spasms which lasted for 1 hour
No h/o LOC, headache
Menstrual History:
AOM - 11yrs
4/30, Regular
No Pain, No clots
Marital History:
ML - 5 months, NCM
Obs History :
3 months of amenorrhea
LMP - 19/01/22
EDD - 26/10/22
POG - 10wks+1 day
T1 : Conceived spontaneously. UPT positive after 1 month of missed period. Early scan done
Folic acid taken
No h/o bleeding/spotting pv
Not a k/c/o DM, HTN, Thyroid, TB, Asthma
O/E :
Pt is conscious
Temp. - 97.9°F
BP - 120/80 mmHg
PR - 79 bpm
RR - 16 cpm
GCS - E4V1M6
No verbal response
Moving all 4 limbs
Tone - Normal
Pupils - B/L NSRL
RS - BAE +, Clear
CVS - S1S2+, No murmurs
P/A - SOFT, NT, BS +
Investigations :
Hemogram, CUE, RFT, LFT, ABG, ECG
ECG
HEMOGRAM
CUE
LFT
Na+ - 138
K+ - 3.6
Cl - 101
Ca - 9.6
Mg - 1.8
Blood urea - 23
Serum creatinine - 0.6
RBS - 105 mg/dl
ABG
Provisional Diagnosis:
Primi 10wks+1day of GA with
?seizures under evaluation
On 01/04/22
S :
No seizure activity since admission
Subjectively feeling better
O:
Pt is conscious, coherent
BP - 130/80mmHg
PR - 85 bpm
CVS - S1S2+, No murmurs
RS - BAE+, clear
P/A - SOFT, NT
A :
Primi 10wks+2days of GA with
? seizures under evaluation
? Hypocalcemia
P:
INJ LEVIPIL 500mg IV BD
INJ OPTINEURON 1amp in 100ml NS IV OD
INJ PAN 40mg IV OD
TAB FOLIC ACID 5mg PO/OD
Plan for 2D ECHO,
USG obs scan with full bladder
Inv. - Reticulocyte count, Peripheral smear, Serum ferritin
Obs scan
Reticulocyte count - 0.7
Peripheral smear :
RBC - Mild anisocytosis with Microcytic hypochromic cells with few normocytes seen
WBC - Within normal limits
PLATELET - Adequate
FERRITIN - 2.6
T3 - 1.13
T4 - 10.08
TSH - 1.31
On 02/04/22
S :
No seizure activity since admission
Subjectively feeling better
O:
Pt is conscious, coherent
BP - 120/70 mmHg
PR - 82 bpm
CVS - S1S2+, No murmurs
RS - BAE+, clear
P/A - SOFT, NT
A :
Primi 10wks+3days of GA with
? Seizures under evaluation
P:
TAB LEVIPIL 500mg PO/BD
INJ OPTINEURON 1amp in 100ml NS IV OD
TAB PAN D 40mg PO/OD
TAB CLOBAZAM 5mg H/S
On 03/04/22
S :
No seizure activity since admission
O:
Pt is conscious, coherent
BP - 130/70mmHg
PR - 76 bpm
CVS - S1S2+, No murmurs
RS - BAE+, clear
P/A - SOFT, NT
A :
Primi 10wks+4days of GA with
? Seizures under evaluation
P:
TAB LEVIPIL 500mg PO/BD
INJ OPTINEURON 1amp in 100ml NS IV OD
TAB PAN D 40mg PO/OD
TAB CLOBAZAM 5mg H/S
On 04/04/22
S :
No seizure activity since admission
No fresh complaints
O:
Pt is conscious, coherent
BP - 110/80mmHg
PR - 78 bpm
CVS - S1S2+, No murmurs
RS - BAE+, clear
P/A - SOFT, NT
A :
Primi 10wks+ 5days of GA with
? Seizures under evaluation
P:
TAB LEVIPIL 500mg PO/BD
INJ OPTINEURON 1amp in 100ml NS IV OD
TAB PAN D 40mg PO/OD
TAB CLOBAZAM 5mg H/S
TAB FOLIC ACID 5mg PO/OD
FINAL DIAGNOSIS :
Primi 10wks+ 5days of GA with K/C/O Seizure disorder ? Conversion disorder
Severe anemia ?IDA
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