18 year old boy with first episode of siezure.

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CHIEF COMPLAINTS:- Involuntary movements of both upper and lower limbs.

HISTORY OF PRESENTING ILLNESS:- 

Patient was apparently asymptomatic 1 day ago , then he developed involuntary movements ,in both upper and lower limbs, which was sudden in onset , associated with shivering,and fever.

He complained of nausea and pain after dinner in the epigastrium which was radiating towards right Iliac fossa and was pricking type with no aggravating and releiving factors.

There was also history of Shortness of breath  1 hr after playing.

At 11.30 pm he was studying, then was feeling uneasy after which he developed involuntary movements of both limbs.

No history of post -ictal confusion, uprolling of eyeballs  tongue bite, involuntary defecation, micturition.

PAST HISTORY:-

No history of HYPERTENSION,DIABETES MELLITUS ,ASTHMA, EPILEPSY, TUBERCULOSIS.

PRESENT HISTORY:

•Diet :- mixed

•Appetite:-normal

•Sleep:- adequate(8 hrs/ day)

•Bowel and bladder:- regular

•Addictions:- nil 

•Allergy:- nil

Family history :- not significant.

GENERAL EXAMINATION:

Patient was conscious,coherent and cooperative,well oriented to time place and person,moderately built and moderately nourished.

•Pallor:- absent

•Icterus:- absent

•Cyanosis:- absent

•Clubbing:- absent

•Lymph nodes:- absent

VITAL SIGNS:

•TEMPERATURE: Afebrile

•BP:140/80 mm Hg

•RR: 22/min

•Spo2:99

•GRBS:130 mg%

SYSTEMIC EXAMINATION:

☆CVS:S1,S2 heard,no murmurs

☆RESPIRATORY SYSTEM:

•trachea central in position

•Normal vesicular breath sounds heard

•BAE ++

☆CNS EXAMINATION:

●CRANIAL NERVES: INTACT 

•Power

Rt UL-5/5. Lt UL-5/5 

Rt LL-5/5. Lt LL-5/5 

•Tone-

Rt UL -N,Lt UL-N

Rt LL-N,Lt LL-N

•Reflexes:. RIGHT LEFT

Biceps        ++            ++

Triceps      ++           ++

Supinator  ++         ++

Knee.            ++       ++

Ankle.          ++          ++

Plantar:. Flexion Flexion       

•SENSORY

crude touch N        N

Pain              N          N

Temperature N      N

Fine touch N             N

 Vibration Right  Left

Upper limb. 15 sec  15 sec

Lower limb. 11 sec  10sec

Tibia             14 sec 14sec

 Toe              15sec   15sec

Finger nose co-ordination : +

ABDOMEN EXAMINATION:

•Inspection :- no scars

•Palpation :- soft,non tender

•Auscultation :- BOWEL SOUNDS

INVESTIGATIONS:-

Haemogram:-

Complete Urine Examination:-

Serum electrolytes:-

BLOOD UREA:

Patient's Value:- 23 mg/dl

Normal value:- 12-42 mg/dl

SERUM MAGNESIUM:

Patient's Value:2.0 mg/dl

Normal value:- 1.8-2.9 mg/dl

SERUM URIC ACID:

Patient's Value:- 4.7 mg%

Normal value:- 3.5-7.2 mg%

BLOOD GROUPING AND RH TYPING:

O+ve blood group

SERUM CREATININE:

Patient's Value: 1.1 mg/dl

Normal value:- 0.9-1.3 mg/dl

PROVISIONAL DIAGNOSIS:- Seizures

MANAGEMENT:- symptomatic management.