78M Involuntary movements1 yr Memory disturbances 1yr
78yr old male,carpenter by occupation came at 2 am On 22-09-23 with complaint of 3 episodes of involuntary movements of both upper and lower limbs since last 6 hours each episode lasting for 5-10 minutes
Patient was completely alright 1 and half year back.
He started having memory issues like
1.He asks customer to pay 5₹ when the actual price is around 100₹
2.He forgets to take the payment
3.He was unable to recollect names of some of his relatives
In Nov 2022,
His wife ,agricultural worker by occupation complained of chest pain,was taken to Suryapet,where they advised them to take her to city.at hey went to KIMS Lb nagar and later shifted to NIMS,where open heart surgery was performed.Patient was mentally disturbed by that incident.
He used to eat(whatever was there in plate)and get freshen up after persuasion by their family members.
His was sad about open heart surgery and so was he. Both(husband and wife)are in the thought process that their money is getting over.Money expenses were 9 lakhs(out of which 5 lakhs were paid by cm fund).
He started talking different sometimes.
1 episode of seizure lasted for 1 minute . Unresponsiveness stiffness of limbs
On dec 10 2022
His wife was discharged from hospital and brought home.
He fell down while getting up and hit his head.
He was unconscious for about 10 minutes.
He was taken to nearby hospital.
March 2023
1.He’s staring at ceiling ,irrevelevant to his surroundings,he is constantly looking around somewhere,not making eye contact. After sometime,he behaves normally(oriented).
2.He had seizure episode- for 5-10 minutes,uprollong of eyeballs was present.Post ictal confusion for 15 minutes.No frothing is seen
Since then, he had a seizure episode once for every month or two.
On 10 September 2023
He had a fever 🤒 till 14th September
On 21 September 2023
Since morning,he was staring at ceiling,other things,not making eye contact,not in this world(said by his attender).Patient responded when called by attenders.
He had 3 episodes of seizures from 9:30 pm till 12 am.
He was brought to us at 2 am 22 sept 2023.
He didn’t have episodes till morning 8:30 am
He had a brief episodes of seizure at 8:30 am and around 9:30 am each lasting for 10-20 seconds
Past History :
K/c/o Hypertension since 8 months on tab.metaprolol 50mg.
Patient is not a known case of Diabetes,Asthma,TB,Epilepsy
Daily Routine :
Before nov 2022,
He woke up at 5am daily,had breakfast and tea at 7 am left to work,come home for lunch at 1pm,again resumed work,drank tea at 4 pm,complete dinner by 8pm and slept through the night.Patient was a friendly and outgoing person
After Nov2022,
He woke up at 5am daily,had breakfast and tea at 7 am stay at home,had lunch at 1pm,again watched tv ,drank tea at 4 pm,complete dinner by 8pm and slept through the night.
They live in 2 room home. They maintain it neat and clean. They eat freshly prepared meals everyday.
Personal History :
Patient takes mixed diet
His appetite decreased from nov 2022
Bowel and bladder habits are regular
No addictions
Patient was deeply disturbed by his wife’s open heart surgery and the couple were worried about their financial security.They are scared of hand loans.They were always bothered about their finances.They have an income if 12,000(from interest on fd and pension)and their expenses are about 8000.
Wife and husband ate well before nov 2022,after that they have consumed non veg rarely (once in a month)
Family history : No significant seizure history in other family members.
He had 3 sons and one daughter
1st child(son)-Died 21years ago(in 2002)at the age of 30 years in nakrekal due to heart attack
2nd child(son)-Died in RTA on spot (in 1990).He was going on a cycle and was hit by lorry.lorry wheels went over his head.
3rd child(son)-He’s reliable attender,working as carpenter,he lives 4-5 houses away.
4th child(daughter)-She’s married and died at the age of 25 years in (1996)within 2 years of marriage and has no kids.
Treatment History :
Quetipine 25mg PO/OD NIGHT
Brivaracetam 50mg PO/BD MORNING NIGHT
Mimantine 10mg and donepazil 5mg PO/OF MORNING
Metaprolol 25mg PO/OD MORNING
Patient is using above medications from nov 2022
after consulting a neurologist.
General examination
Patient is conscious
No pallor,icterus,cyanosis,clubbing,
lymphadenopathy,pedal edema
Involuntary movements of right upper limb present
Bp-130/90 mmHg
Pr-73bpm
Rr-19cpm
Saturations-98%
Systemic examination
CVS:S1 S2 heard,no murmurs
P/A: soft ,non tender,Bowel sounds heard
RS: BAE+ NVBS+,
CNS EXAMINATION:
Right left
Power UL 5/5 5/5
LL 5/5 5/5
Tone UL N N
LL N N
Reflexes - Biceps Triceps Supinator
R 2+ 1+ 1+
L 2+ 1+ 1+
Reflexes- Knee Ankle Plantar
R 2+ 1+ Decreased
L 2+ 1+ Decreased
22/09/23- 3 episodes of seizures
23/09/23- 6-8 episodes of seizures
24/09/23- c/o seizures decreased
25/09/23- c/o seizures decreased
26/09/23- no seizure activity
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