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CASE OF FOCAL SEIZURES

PRESENTED BY: MAJ ARVIND KUMAR DISCUSSED BY: WG CDR K S MULTANI

Case details

11 yr old male child Product of non consanguinous marriage Informant- father Resident of BHIWANI(HARYANA) Reliability -good

Presenting complaints

One episode of loss of consciousness with generalized seizures - 24 hrs before Weakness of left upper limb x 24 hrs Headache 24 hrs

HISTORY OF PRESENT ILLNESS

Apparently well child till one day back while playing carrom ,he developed pain and numbness in left upper limb. Soon he developed generalized seizures
Associated with loss of consciousness Deviation of angle of mouth Up rolling of eye balls Lasted for 03 minutes

HOPI contd

H/O WEAKNESS UPPER LEFT LIMB Acute onset,involving elbow ,wrist and finger grips NonProgressive HEADACHE

B/L FRONTAL REGION MILD CONTINOUS

NEGATIVE HISTORY

No H/o of
NO BOWL/BLADDER INCOTINENCE NO POOLING OF SALIVA,DYSPHAGIA,NASAL REGURGITATION FLUSHING/SWEATING/GIDDINESS FEVER COUGH CHEST PAIN OR PALPITATION VOMITING/DIARRHEA

PAST HISTORY

No past h/o seizures No other significant history

FAMILY HISTORY

Nonconsaguinous marriage No h/o seizures,neurological disorders Mother has completed ATT course 07 yrs back for pulmonary T B .

13yrs

11yrs

IMMUNISATION HISTORY

As per UIP No optional vaccines BCG scar mark present

DEVELOPMENTAL HISTORY

Studying in 7th class Good scholastic performance

SOCIAL HISTORY

4 family members Nuclear middle class 2 rooms + kitchen Ventilation adequate

Summary after history

11 yr old male child apparently well 1 days back, presented with h/o one episode of generalized seizures of 3 minutes duration followed by weakness and numbness in upper left limb and frontal headache with family h/o pulmonary tuberculosis in mother 07 yrs back,had completed ATT course

General examination

Child is conscious ,oriented to time, place ,sitting on bed comfortably Afebrile Pulse- 88/min,all peripheral pulses well felt,sinus arythmia R/R- 20/min BP- 110/68mm Hg RAS CFT < 2 sec No pallor /icterus /cyanosis/ clubbing/lymphadenopathy/ pedal oedema No neurocutaneous markers

Anthropometry

Weight- 35kg (25-50th p ) Height- 146.7 cm (50-75th p) Nutritional status WNL

CNS

HMF normal Speech normal Cranial nerves normal

Fundoscopy normal

CNS contd

MOTOR SYSTEM

Bulk normal Tone

UL LL

N N

Power

Power UL LL

Rt

Lt

5/5 4/5 5/5 5/5

CNS contd

Reflexes bicep ++ + tricep + + supintr knee + + ++ ++ ankle + + plantar flexor flexor

reflex RT LT

Superficial reflexes intact No sensory loss Gait normal Skull/spine normal

Resp
B/L equal air entry vesicular breath sounds

CVS SI S2 normal,no murmur Abdomen


Soft ,no organomegaly B/S +

SUMMARY

11 yr old male child apparently well 1 days back, presented with h/o one episode of generalized seizures ,presently having some weakness in left upper limb and frontal headache

INVESTIGATIONS

Hb-12.3gm% TLC-9500 DLC-P53 L41 Platelets- 2.6 lacs PBS for MP- Neg ICT for MP VE BUN-10 Creatinine- 0.8

INVESTIGATION

Na 140 K 4.2 Cl 101 Ca 3.6 repeat 4.4 Urine normal LFT normal CPK 14 U/L Montoux test negative

CXR normal ECG normal USG abdomen normal MRI Brain showed ring enhancing lesions in posterior parietal lobe Rt side with perilesional edema,suggestive of tuberculoma.

DIAGNOSIS

Functional -Monoparesis Anatomical - UMN type Etiological -TUBERCULOMA

FINAL DIAGNOSIS

TUBERCULOMA IN RT PARIETAL LOBE

MANAGEMENT

Definitive

ATT

Supportive
STEROIDS ANTI EPILEPTIC Watch out for SEIZURES

COURSE IN HOSP

Child was seizures free Showed improvement in power in left upper limb Got relief from headache Tolerating ATT well

THANK

YOU

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