46 year old male who is a daily wage labourer by occupation came with complaints of
fever since 5-6 days,
A single episode of involuntary movements 29th jan at 6pm.
History of present illness :
Patient was apparently asymptomatic 6 days back then he developed low grade fever which is on and off which is sudden in onset and associated with chills and is not associated with cold and cough, no aggrevating factors
but relieved on taking medications. It is also a/w tooth ache due to which he is unable to take/ chew foods.
He developed generalised weakness and tingling sensations since 15days
He had a single episode of involuntary movements for 5 minutes yesterday, associated with uprolling of eyes, frothing of saliva present (? Tonic type of seizues), no involuntary passage of urine and stools, post ictal confusion for 30 minutes after the episode of seizures.
No h/o chest pain, palpitations, syncopal attacks.
No h/o shortness of breath, orthopnea and PND.
H/o 7-8 episodes loss of consciousness after alcohol binge.
He c/o reddish colour urine 5-6days back which subsided on its own.
Past medical history :
No similar complaints in the past.
No h/o HTN, Type 2 DM, CVA, TB, Asthma, CAD.
Past surgical history:
Excision of small swellings around neck 20 years back.
Personal history :
Diet is mixed, with normal appetite, sleep is adequate, with regular bowel and bladder movements.he is a chronic alcoholic and chronic smoker with 20 pack years.
General examination : patient is conscious, coherent and cooperative.
No signs of pallor, icterus, cyanosis, clubbing, lymphadenopathy and edema.
Vitals:
Patient is afebrile,
Bp 130/90mmhg,
PR 83bpm
RR 17cpm
Spo2 98% @ RA
Systemic examination :
CNS examination:
Higher motor funtions normal
patient is conscious and oriented to place/time/person.
All cranial nerves- intact
MOTOR SYSTEM
Left. Right
Bulk: inspection Normal normal palpation Normal Normal
Measurements U/L Equal on both sides
L/L Equal on both sides
Tone:
UL Normal Normal
LL Normal Normal
Power :
UL 5/5 5/5
LL 5/5 5/5
Reflexes: absent
SENSORY SYSTEM
RIGHT. LEFT
SPINOTHALAMIC
crude touch. N. N
pain. N. N
temperature. N. N
post:
fine touch. N. N
vibration. N. N
position sensor. N. N
cortical
2 point discrimination N. N
tactile localisation. N. N
CEREBELLAR SIGNS - normal
No meningeal signs.
CVS examination :
S1,S2 heard ,no murmurs.
RESPIRATORY SYSTEM EXAMINATION -bilateral air entry present , normal vesicular breath sounds heard. no added sounds.Trachea is central in position
PER ABDOMEN EXAMINATION:
Scaphoid in shape,no tenderness and no palpable mass present.Hernial orifices are free.Liver and spleen are not palpable.Bowel sounds are present..
INVESTIGATIONS:
Diagnosis:
?Alcoholic withdrawal seizures.
?Alchol induced thrombocytopenia
TREATMENT:
1) IVF 0.9% NS with 1ml optineurin IV/ OD.
2) Inj THIAMINE 1Amp in 100ml NS IV / BD.
3) watch for seizure episodes
4) Tab NITROFURANTOIN 100mg BD.
5) Tab PAN 40mg OD.
