45 YRS OLD MALE CAME TO GM OPD WITH SEIZURES

This is a case of 45 Yr old male resident of chityala,farmer by occupation came to gm opd WITH

CHIEF COMPLAINTS :

One episode of seizures 1 week back and he had bleeding from mouth due bitting tongue during the episode

##HISTORY OF PRESENTING ILLNESS#

Patient was apparently asymptomatic 20 yrs ago .he was alcoholic then, he started with toddy for 3yrs and continued with BRANDY due work stress,and family issues.he had a episode of seizures after consuming alcohol in year 2020

Again had 3 episodes of seizures in the interval of 2018_ 19,went to local doctor and it subsided, did stop drinking for a 6 month period.

Recently he started drinking and Patient was apparently asymptomatic 1 week back, then he has an episode seizures while he was doing his work on monday .then he went to the local doctor for the treatment he had given a tablet for it and the seizures subsided .he came to the opd on wednesday and he was advised for the investigation .

he refused due to lack of money and went back home
he came back again to the opd for the treatment on 3rd DEC 2022 after an episode again

PAST HISTORY:

He had a history of episode of seizures 2 year back

*he had three episodes of in six months .

Not a k/c/o HTN, DM, CAD, ASTHMA, EPILEPSY, THYROID DISEASE

PERSONAL HISTORY:

Appetite decreased,

Sleep adequate,

bowel movements regular,

bladder regular,

addictions: he consumes alcohol every one week from 25 years amount 90Ml in morning and 45 to 50 ml in the evening

he had consumed alcohol the day before he had seizers 180 ml

smoker ( kini ) : every day since 7 years ( 1 packet =2 days ).

DAILY ROUTINE:

FAMILY HISTORY:

not significant family history

ALLERGIE HISTORY:

Not allergic any food or medication

Not allergic to any drugs.

GENERAL EXAMINATION:

Patient is conscious, coherent and non cooperative

he is well oriented to time, place, person.

examined in a well lit area

moderately built and moderately nourished

Pallor- Absent

Icterus- Absent

cyanosis- Absent

Clubbing-Absent

Lymphadenopathy- Absent

Pedal edema- Absent.

"VITALS" :

Temperature - 98.6 F
Pulse rate - 79 beats per min
respiratory rate - 24breaths per min
Blood Pressure -140/80 mm of Hg.

SYSTEMIC EXAMINATION:

CNS:

HIGHER MENTAL FUNCTIONS:

Right Handed person, he studied upto 10th standard.

Conscious, oriented to time place and person.

Mini mental state examination::26/30.

speech : normal

Behavior : normal

Memory : Intact

Intelligence : Normal

Lobar Functions : Normal.

No hallucinations or delusions.

CRANIAL NERVE EXAMINATION:

1st : Normal

2nd : visual field is normal

visual acuity is normal

colour vision normal

fundal glow present.

3rd,4th,6th : pupillary reflexes present.

EOM full range of motion present

gaze evoked Nystagmus present

5th : sensory intact

motor intact

7th : normal

8th : No abnormality noted.

9th,10th : palatal movements present and equal.

11th,12th : normal.

MOTOR EXAMINATION: Left. Right

UL. LL. UL. LL

BULK N N. N. N

TONE

N. N. N. N

POWER 5/5 5/5 5/5 5/5

DEEP TENDON REFLEXES:

BICEPS 2+ 2+ 2 + 2+

https://youtube.com/shorts/K20Eu4nPXlA?feature=share

TRICEPS 2+ 2+ 2+ 2+

KNEE 2+ 2+ 2 + 2+

https://youtube.com/shorts/tIkZYAvuqxY?feature=share

GAIT: normal gait

::::RESPIRATORY EXAMINATION:::

Patient examined in sitting position
Inspection:- Chest appears Bilaterally symmetrical & elliptical in shape. Respiratory movements appear equal on both sides and it's Abdominothoracic type.
Trachea central in position
Palpation:-
All inspiratory findings confirmed
Trachea central in position . Apical impulse in left 5th ICS, 1cm medial to mid clavicular line
.
Percussion:- all areas are resonant
Auscultation:- Normal vesicular Breath sounds (NVBS)

::::CVS::

S1, S2 heard, no murmurs,

apex beat in 5 th ICS, MCL

Abdominal examination:
Abdomen is soft and non tender
No organomegaly
No shifting dullness
No fluid thrill

LAB INVESTIGATIONS:

On 3/12/2022:

on 4th dec 2022: