18 yr old female with Neurocysticercosis presented with seizures

  This is online E log book to discuss our patient’s de-identified health data shared after taking his/her/guardian’s signed informed consent. Here we discuss our individual patient’s problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problems with collective current best evidence based inputs. This e-log book also reflects my patient centered online learning portfolio and your valuable inputs on comment box is welcome.

 I have been given this case to solve in an attempt to understand the topic of “patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations, and come up with diagnosis and treatment plan


M.Abhignya

Roll.No. 83

CASE HISTORY:

February 10, 2023
  

18 yr old female, resident of narketpally, complains of 3 episodes of seizures since yesterday night
History of present illnesses:
Pt was apparently asymptomatic till last night, at 12 am, in her sleep, she had an episode of Generalised tonic clonic seizures with tongue bite, dribbling of saliva, post ictal confusion and uprolling of eyeballs and gained consiousness after 10min
Similar episodes took place at 4am and 11.30am
No involuntary micturation or defecation
C/o headache in frontal region, non radiating
C/o nausea since morning
C/o fever since 20 days,low grade,intermittent type,no diurnal variation, not associated with chills and rigor






No c/o cough, cold, chest pain, orthopnea, pnd, burning micturation, loose stools, vomitings
Past history:
K/c/o seizures since 1yr, used medication for 1 month, and stopped after that
Not a k/c/o DM,HTN,TB,Asthma,CAD
General Examination:
Pt.is conscious, coherent, cooperative 
No pallor, icterus, cyanosis, clubbing, lymphadenopathy, pedaledema 

Vitals:
Pr 108 bpm
Bp 110/70 mmHg
Rr 14 cpm
Spo2 99%
Grbs 92 mg/dl
System Examination:
Cvs: s1,s2 heard,no murmurs 
Rs: BAE present 
P/A: soft, non tender 

CNS:
Pt is conscious, 
Speech is normal
No meningeal signs
Normal cranial nerve examination, motor system, sensory system
Gcs: E4,V5,M6
Reflexes:
       R  L
B  +++  +++
T  +++  ++
S  ++    ++
K  +++  +++
A  +++  +++
P Flexor Flexor

Investigations:


HEMOGRAM:

10/2/23
HB -11.8GM/DL
TOTAL COUNT- 8,500CELLS/CUMM
PLATELET- 1.0LAKHS/CUMM

ON 12/02/23
HB- 11GM%
TOTAL COUNT- 10,000
PLATELET- 2.08

ON13/02/23
HB- 11.1GM%
TOTAL COUNT- 11000CELLS/CUMM
PLATELET- 2.39LAKHS/CUMM

ON14/02/23
HB- 12.9GM%
TOTAL COUNT- 10,100CELLS/CUMM
PLATELET- 2.65LAKHS/CUMM

ON15/02/23
HB- 12.5GM%
TOTAL COUNT- 7,300CELLS/CUMM
PLATELET- 2.51LAKHS/CUMM
BGT: A positive







MRI Brain:
Well defined cortical / subcortical based ring enhancing lesion seen in left basifrontal region with significant perilesional edema in frontal lobe--likely suggestive of Neurocysticercosis/Tuberculoma













USG Abdomen:
No sonological abnormality detected



ECG:



2D echo:



Diagnosis:
Neurocystcercosis presented with seizures 

Treatment:
IV fluids NS @50ml/hr
Inj levipil 1Gm in 100ml NS. IV /Stat, followed by 500mg iv bd
Inj optineuron 1amp in 100ml ns iv od
Inj.Dexa 
T zofer po sos
T dolo 650mg po sos
Monitor vitals

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