65 y old female came with history of seizures

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A 65yr old female resident of lingotum with history of seizures 

Chief complaints:-

The patient was brought to casuality with chief complaints of Active involuntary movements ,since 30 minutes, history of frothing , mouth deviation to left uprolling eyeball ,no h/o of tongue bite, urinary incontinence, fever, head injury, vomitings, loose stools.

HISTORY OF PRESENTING ILLNESS:-

Patient was apparently asymptomatic 30 mins back later she developed sudden onset of movements in upper and lower limbs for 5 minutes.

typical episode begins with headache and dizziness, up-rolling of the eyes followed by loss of consciousness and uncontrolled involuntary movements of the arms and legs, clasping of the hands and deviation of the mouth to one side. Frothing and tongue bite was seen in the initial years. She usually regains consciousness 5-10 minutes later in a confused state, with no memory of the episode. There have been instances of falling to the floor when no one was around to help her. 

Current presentation - 

Current episode began in the night time she also had complaints of headache dragging type pain radiating to neck . This was followed by uprolling of the eyeballs loss of consciousness and sudden onset of involuntary movements, frothing, deviation of mouth towards left and confusion in postictal period.

No h/o episode of seizure activity after bringing to casualty 

no h/o of involuntary defecation

no h/o fever, cough, vomitings, loose stools, pain in abdomen.

PAST HISTORY:-

Similar episode 5 days ago for which she visited a local hospital and got treated .

K/C/O hypertension since 18 years on medication not a known case of DM/HTN/TB/Asthma/CVD/CAD

TREATMENT HISTORY:-

On treatment for hypertension since 18 years 

Personal History -

Appetite - Normal 

Diet - mixed 

Bowel and bladder movement are regular

Sleep adequate 

No addictions 

Family history - not relevant

General examination

Patient is conscious, coherent and cooperative 

Moderately built and nourished 

Icterus - Absent

Cyanosis - Absent

Clubbing - Absent

Lymphadenopathy - Absent

Pedal edema-absent

VITALS:-

Tempurature - 98 F

Pulse- 78 bpm 

Blood pressure - 140/90 mmhg

Respiratory rate - 18 cpm

spo2- 99

grbs- 117 mg %

SYSTEMIC EXAMINATION:-

CNS examination

Motor system

Bulk - no wasting of muscle 

Tone - normal 

Power grading - 

                       Right. Left 

Upperlimb +5. +5

Lowerlimb +5. +5

Reflexes - 

Biceps - normal 

Triceps - normal

Knee jerk 

Ankle jerk 

Sensory system - fine touch , crude touch , pain , temperature sensation are intact 

CVS examination

Inspection:-

JVP not seen

Auscultation

S1 S2 heard , no murmurs 

RESPIRATORY SYSTEM

chest is bilaterally symmetrical 

bilateral airway entry present

trachea - Midline 

no scars

Percussion:-Resonant in nine quadrants

Auscultation- Normal vesicular breath sounds heard

ABDOMINAL EXAMINATION

shape- scaphoid

no tenderness

liver not palpable

spleen not palpable

Provisional diagnosis -

This is a case of 65 year old woman who came with complaint of abnormal movement of hands and limbs lasting for 5 mins preceded by headache suggestive of generalized tonic clinic seizure.