A 45year old female was bought to casuality with involuntary movements of upper limb and lower limb

This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here, we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs

CHIEF COMPLAINT
- Involuntary movements of upper and lower limb at night.
- One episode at 10 pm
- Subsided in few minutes, and other episodes in between 2am- 5am with intermittently regaining       consciousness in between.
-Seizures were tonic type involving all four limbs with deviation of mouth and uprolling of eyes, frothing and involuntary micturition.
-She presented to casuality with confused state.


HISTORY OF PRESENT ILLNESS
-She is a resident of beemavaram village and has with 2 children , her husband left her 15 years ago, he was a chronic alchoholic. 
-Since then she was in depression and has suicidal tendencies with history of starvation and inducing vomiting after food intake.
- No h/o fever, cough, headache.

HISTORY OF PAST ILLNESS
- History of weight loss since 10 years with loss of appetite.
- One PRBC transfused 4 years ago in view of anemia.
- 3 years ago patient had one episode of tonic movement of all 4 limbs with deviation of mouth, tonic type lasting for few minutes and was started on tab.levipil 500mg/od
- patient used to take her medication regularly but still has one episode of seizures every 3 months and which used to resolve with medication

TREATMENT HISTORY
- No h/o Diabetes
-No h/o Hypertension
- No h/o Asthma
-No h/o TB
-No h/o surgeries in past
-No h/o previous radiations
-No allergy to drugs

MENSTRUAL HISTORY
- once in 15 days or once in 2-3 months

PERSONAL HISTORY
-Married
-loss of appetite
-diet: mixed
- bowel movements: regular
- sleep- irregular
-No addictions

FAMILY HISTORY
No h/o similar complaints in family members.

GENERAL EXAMINATION
-Patient was non conscious, non coherent and non cooperative 
- Patient was not well nourished and not built.
-Anemia present
-No dyspnea
-No clubbing
-No generalized lymphadenopathy
- No pedal edema

SYSTEMIC EXAMINATION
Cardio vascular system
- cardiac sounds: S1,S2 are heard
-No murmurs

Respiratory system
- breath sounds: vesicular

Central nervous system
- patient was confused
- patient is non-conscious

DIAGNOSIS
- This case is diagnosed to be status epilepticus.

TREATMENT
- Inj. ceftriaxone 1gm
- Inj. pantop 40mg
- Inj. zover 4mg
- Inj. levipil 500mg
- Inj. optineuron IN 500mg
- Inj. lurazepam
- Tab. plm 650mg
- Tab. ecosprin
- Protein X powder

ECG






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