AMC Unit-4 Admission
A 55 year old male, farmer by occupation who is a chronic alcoholic since 25 years presented to casuality with C/O involuntary movement of hands and legs - 2 episodes since yesterday
HOPI:
Patient was apparently asymptomatic 1 year ago and then he developed
First Episode:
Patient had clonic movements of upper limb for 1 minute at 11:00 am on 22/12/2020
H/O stared look for 5 mins associated with involuntary micturition
H/O tongue bite +
Postictal frothing +
Postictal Confusion for 30 minutes +
No H/O Pain Abdomen, burning micturition
Tremors +
BP was found to be 180/100 mmHg
Patient was advised to stop alcohol and was sent for psychiatry opinion in view of alcohol withdrawal
Patient later again had clonic movements of upper limb at 4 pm leading to sudden fall causing injury to the right frontal region
Postictal Confusion for 10 minutes +
Uprolling of eyeballs +
Tongue bite +
Frothing +
Involuntary micturition +
No H/O Vomitings
Patient had binge of alcohol for 10 days continuously and had stopped that morning
MRI Brain was done on 22/12/2021 which showed features suggestive of Late Subacute to Chronic Haemorrhage in Left Putamen/External Capsule
Patient was started on TAB. LEVIPIL 500 mg/PO/BD and was asked to continue medication till 2 years of seizure free period but he had stopped taking medication one week after being discharged
On 9/12/2021:
Patient came to casuality with C/O 2 episodes (one episode on 8/12/21 at 7:30 pm and second episode on 9/12/21 at 10:30 am) of involuntary movements of upper and lower limbs since yesterday, each episode lasting for 2-2 1/2 mins associated with -
Drooling of saliva +
Involuntary micturition +
Tongue bite +
No uprolling of eyeballs
No involuntary defecation
H/O Alcohol binge present before both the episodes of seizures.
Patient consumed alcohol for 10 days (12 units - 360 ml whiskey) followed by abstinence for a day or two, leading into seizures.
Last alcoholic drink - 30 ml (1 unit whiskey) after seizure episode
Psychiatry referral I/v/o ?Alcohol withdrawal seizures with alcohol dependence syndrome
Advice given:
Patient is not a K/C/O DM/HTN/TB
PERSONAL HISTORY:
Diet - mixed
Appetite - no food intake from the last 10 days
Sleep - disturbed
Bowel habits - regular
Micturition - normal
No known allergies
Chronic Alcoholic since the last 25 years with daily intake of 90-180 ml increasing quantity progressively
No H/O Smoking
Family History - Not significant
GENERAL EXAMINATION:
No pallor, icterus, cyanosis,clubbing lymphadenopathy, edema
Patient is Afebrile
PR - 92 bpm
RR - 18 cpm
BP - 150/90 mmHg
SpO2 - 99% at RA
GRBS - 199 mg/dL
SYSTEMIC EXAMINATION:
CVS - S1, S2 heard , No murmurs
RS - BAE +, NVBS +
P/A - Soft, Non tender
CNS -
Patient in a confused state and is irritable
Speech- Incoherent
Gait-
No signs of meningeal irritation
Cranial nerves - intact
Motor and sensory systems - intact
Reflexes - RIGHT LEFT
Biceps 2+ 2+
Triceps 2+ 2+
Supinator. 2+ 2+
Knee. 2+ 2+
Ankle. 2+ 2+
Plantar. Flexion. Flexion
PROVISIONAL DIAGNOSIS:
?Alcohol Withdrawal Seizures with Alcohol dependence syndrome/?Epileptic Disorder
TREATMENT GIVEN:
1. Inj. Thiamine 200 mg IV/TID in 100 ml NS
2. Inj. LEVIPIL 1 gm IV/STAT
3. Inj. Optineuron 1 amp in 100 ml NS IV/OD
4. Inj. Lorazepam 2 cc IV SOS
Soap notes
Gm ward :11/12/2021
56 year old male
S- no fresh complaints
O-
Pt is c/c/c
Afebrile
Bp : 120/80 mm hg
Pr : 82 bpm
RR 22 cpm
Spo2: 97%@ room air
GRBS :123 mg/dl
Systemic examination:
CVS :S1,S2 +
RS : BAE+
P/A : soft,non tender
CNS : NAD
Diagnosis:
A 56 year old male patient with ? Alcohol withdrawal seizures/ ? Epileptic disorder
Plan of treatment:
1 INJ Thiamine in 100 ml NS/IV/TID
2 INJ OPTINNEURON IN 100 ML NS/IV/OD
3 W/F SEIZURE ACTIVITY
4 INJ PANTOP 40MG /IV/OD
5 INJ LORAZEPAM 2CC IV/sos
6 TAB LIBRIUM 25mg
1---X---2
7 TAB LIOFEN XL 20mg PO/BD
8 TAB LEVIPIL 500MG PO/BD
Advice discharge
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