Friday, 1 April 2022

e log 1

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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