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25 year old male patient came to opd with
CHEIF complaints of :-
Involuntary movement of right upper limb 15 days back and followed by loss of consciousness for 2-3 minutes
HOPI:-
Patient was apparently asymptomatic 15 days back then he had involuntary movement of right upper limb followed by loss of consciousness for 2-3 minutes which is A/w TONGUE BITE. NOT A/w post ictal confusion, nausea, giddiness
H\O pork intake 6 months back
Patient had involuntary movements of right upper limb followed by loss of consciousness for 2-3 minutes associated with tongue bite, no post ictal confusion, nausea and giddiness at 12 and 10 years of age and was on medication T. Tegrital 100 mg
PAST HISTORY:-
K/C/O epilepsy
- 1 episode at 10 Years of age
- 2 episode at 12 years of age
- stopped using medication since 13 years of age
Not A/ K/C/O - HTN , TB,ASTHMA DM
PERSONAL HISTORY:-
SLEEP- ADEQUATE
DIET - MIXED
BOWEL AND BLADDER MOVEMENTS- REGULAR
HABITS-
once in 2-3 days 2 beers and 90 ml whiskey
FAMILY HISTORY :-
No significant family history
TREAMENT HISTORY:-
T. Tegrital 100 mg
GENERAL EXAMINATION:-
Patient is c/c/c
No pallor , icterus, cyanosis, clubbing, lymphadenopathy, pedal edema
Bp - 130/90 mmHg
Pr - 84 bpm
Temp - Afebrile
SYSTEMIC EXAMINATION:-
CVS Examination
- s1,s2 +
- no murmurs
RESPIRATORY EXAMINATION:
Chest bilaterally symmetrical, all quadrants
moves equally with respiration
Trachea central, chest expansion normal
No added sounds
BLAE +
NVBS +
ABDOMINAL EXAMINATION :-
- SOFT NONTENDER
- NO SCARS
- NO SINUS
- NO ENGARGED VEINS
CNS EXAMINATION:-
CNS EXAMINATION:
Right handed person
HIGHER MENTAL FUNCTION
Counsious , coherent, cooperative,well oreinted to time place person
Speech normal
Behaviour normal
Memory intact
Intelligence normal
CRANIAL NERVE EXAMINATION
-OLFACTORY-normal
- optic : normal visual field
-oculomotor,trochlear,abducens facial-intact
- vestibulocochlear- intact
- glossopharyngeal -intact
- vagus-intact
-accesory spinal ganglion nerve intact
- hypoglossal intact
Sensory system:
-fine touch: intact
-pain: normal
-temperature - normal
- vibration -normal
-stereognosis- normal
-two point discrimination-present
Motor system examination
Nutrition -
U/L. R. L
Normal. Normal
L/L. Normal. Normal
TONE:
U/L. R. L.
Normotania. Narmotonia
L/L
Normotonia. Normotonia
POWER. :- RIGHT. LEFT.
SHOULDER
flexion : 5/5 5/5
Extension 5/5. 5/5
Abduction 5/5. 5/5
Adduction 5/5. 5/5
Internal rotation 5/5. 5/5
External rotation 5/5. 5/5
Elbow:5/5. 5/5
Flexion. 5/5. 5/5
Extension:5/5. 5/5
Wrist:5/5. 5/5
Flexion:5/5. 5/5
Extension:5/5. 5/5
Abduction : 5/5. 5/5
adduction:5/5. 5/5
Hip
Flexion:5/5. 5/5
Extension. 5/5. 5/5
Abduction:5/5. 5/5
Adduction 5/5. 5/5
Internal rotation:5/5. 5/5
External rotation. 5/5. 5/5
Knee 5/5. 5/5
Flexion 5/5. 5/5
Extension. 5/5. 5/5
Ankle. 5/5. 5/5
Plantarflexion:. 5 /5. 5/5
Dorsiflexion. 5/5. 5/5
Toe. 5/5 5/5
Movements:5/5
REFLEXES:
Corneal present
Conjunctival present
Abdominal: present
Plantar: present
https://youtube.com/shorts/z3fpUJUdcAY?feature=share
DEEP REFLEXES:
Biceps : 5+. 5+
Triceps 5+. 5+
Knee : 5+. 5+
https://youtube.com/shorts/7sQEvOZOprc?feature=share
Ankle: 5+. 5+
CEREBELLAR
NYSTAGMUS absent
DYSADEADOCHOKINESIA absent
FINGER NOSE tip- normal
Rhomberg sign
Rebound phenomenon present
Heel to knee intact
https://youtube.com/shorts/f9nrPRcUWtE?feature=share
Gait :- normal
Meningial sign
Kernigs sign negative
Brudzinski sign negetive
Investigations:- on 25 th November
USG report:
On 28 th November
Provisional diagnosis:-
Right hand complex partial seizures due to old infract
? Neurocysticercosis
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