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 

  Geographic tongue 
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



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