# data[].attributes.body
suddenly stood up from the table, started making an ‘mm sounds, and wandered around before collapsing to the ground, looking stiff followed by a few jerks = patient is having tonic-clonic seizure. Tonic stage characterized by loss of consciousness and body stiffness. Clonic characterised by twitching/jerking movement of muscle. Patient collapse. Generalized seizure. Formerly known as grand mal seizure

regained consciousness after about a minute = The seizure episode last exactly 1 minute. Due to focal seizure, tonic-clonic seizure

had bitten her tongue = Due to involuntary jaw muscles movement.

confused about 30 minutes after that gradually recovered = In postictal state, common in seizure patient, due to neuronal exhaustion and hyperinhibition. To balance patient condition to normal. Increase excitation of glutamate and decrease inhibiton of GABA

can’t recall the event = Postical state. Common features. Postical amnesia

very tired because she had been up late completing monthly
reports for the past two nights = Indication of stress-induced seizure

mild headache, myalgias, and a “sore tongue”. = Postical symptom. Change in cerebellar blood flow. Muscle contract forcefully. Sore tongue due to bitten tongue

similar episode about 6 months ago = Doesnt not necessarily mean epilepsy, but may be indicative of epilepsy

bewildered, walking around the office and muttering to herself = Manifestation of seizure. Suggest a range of issues such as stress-induced seizure

put this down to stress. = Pt thought that she doesnt have seizure. doesnt seek medical consultation and doesnt take any medication, thus causing progression to generalised seizure

no prior history of predisposing neurological conditions or comorbidity. = Pt have lower risk of seizure caused by neurological conditions and comorbidity. such as AVM

not on any prescription or over-the-counter medications = Rule out drug-induced seizure

No history of recent trauma or surgical procedures. History of mild concussion as a child while playing sports. = May lead to some neurological disturbances such as epilepsy, migraine and cognitive impairment

No family history of similar illness or epilepsy. = Rule out genetic causes of seizure

no history of alcohol abuse or illicit drug use = Rule out alcohol withdrawal and drug-induced seizure

DIFF DIAGNOSIS

epilepsy

infection (meningitis)

traumatic brain injury

brain tumor

drug induced seizures (antidepressant, antipsycho

alcohol withdrawal

metabolic disorder (hyper/hypoglycemia)

stress induced seizures

genetic disorder

FURTHER IX

Vital sign: temp, heart rate, respiratory rate, blood pressure

Physical examination: Observe pt general appearance, pallor, cyanosis, alertness, and consciousness, any sign of neurological deficit

Neurological examination: GCS to examine pt consciousness, grade 3 is minimal grade and 15 is max

EEG: Electrical activity of brain. Diagnose epilepsy

ECG: Electrical activity of heart. Rule out cardiac cause of seizure

Systemic examination: Check for underlying causes.

Serum electrolyte: Check for imbalance of electrolytes

MRI: Check for brain lesion

# data[].attributes.body
seizures - a burst of uncontrolled electrical activity between brain cells that causes temporarily abnormalities in ms tone/movement, behaviours, sensations or states of awareness

# data[].attributes.body
24y/o - young adult, well develop, low risk to get dx

woman - male>woman. certain conditions woman high risk getting seizures (pregnancy, menopause - fluctuations of estrogen & progestrone level > seizures)

was brought to hosp by her mother - serious condition, mother worried about daughter health . pt unconsciouss

seizures - diff with epilepsy

focal - in specific area of brain (Conscious)

generalised - involve whole brain, whole hemisphere, bilateral (unconscious)

DIFF DIAGNOSIS

epilepsy

infection (meningitis)

traumatic brain injury

brain tumor

drug induced seizures (antidepressant, antipsycho

alcohol w/drawal (less likely)

metabolic disorder (hyper/hypoglycemia)

stress induced seizures

genetic disorder

FURTHER IX

HOPI - SOCRATES (open questions)

PMH - take any medications? past surgery?

FH - family members having same symptoms, known hereditary dx (epilepsy)

SH - Marriage status, smoking (CVD risk profile), alcohol, occupation

Stress level - mental health

# data[].attributes.body
suddenly stood up from the table, started
making an ‘mm sounds, and wandered around before collapsing to the ground

looking stiff followed by a few jerks

regained consciousness after about a minute

had bitten her tongue

confused about 30 minutes after that gradually recovered

can’t recall the event

very tired because she had been up late completing monthly
reports for the past two nights

mild headache, myalgias, and a “sore tongue”.

similar episode about 6 months ago

bewildered, walking around the
office and muttering to herself

put this down to stress.

no prior history of predisposing neurological conditions or comorbidity.

not on any prescription or over-the-counter medications

No history of recent trauma or surgical procedures. History of mild concussion as a child while playing sports.
No family history of similar illness or epilepsy.

no history of alcohol abuse or illicit drug use

# data[].attributes.body
jerk - Sudden and involuntary muscle movement

myalgia - Muscle ache and pain , involve ligaments, tendon and muscles cramp

Sore tongue - known as white tongue. discomfort pain or irritation in tongue. Mostly due to trauma injuries

bewildered - State of confusion, perplexity, and disorientation

concussion - type of traumatic brain injury caused by blunt blow, or jolt to the head. Causes the head and brain to move rapidly back and forth

muttering - Low volume speech, mumbling

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Spike wave - pattern of EEG observed

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Vital signs: ALL NORMAL

Blood test:

WBC slightly elevated (due to demargination of leukocytes, secondary to muscular activity during seizure)

Others normal

EEG showed left anterior and mid-temporal spike waves consistent with a left temporal focus - there is abnormal electrical discharge at left anterior and mid temporal part of the brain, patient may have temporal lobe seizure, affects hippocampus and memory

# data[].attributes.body
Vital signs: ALL NORMAL

Blood test:

WBC slightly elevated (due to demargination of leukocytes, secondary to muscular activity during seizure)

Others normal

EEG showed left anterior and mid-temporal spike waves consistent with a left temporal focus - there is abnormal electrical discharge at left anterior and mid temporal part of the brain, patient may have temporal lobe seizure, affects hippocampus and memory

DIFF DIAGNOSIS

epilepsy (temporal lobe, focal, tonic-clonic seizure

infection (meningitis)

traumatic brain injury

brain tumor

drug induced seizures (antidepressant, antipsycho

alcohol withdrawal

metabolic disorder (hyper/hypoglycemia)

stress induced seizures

genetic disorder

# data[].attributes.body
1. reduction in left hippocampal volume

2. no hippocampal sclerosis\

3. diagnosed with temporal lobe epilepsy with simple focal,complex focal and secondarily generalised seizures

4. explained the risk of subsequent seizures and complications of seizure.

5. treated with lamotrigine

# data[].attributes.body
1. hippocampal volume- cognition, speech. emotion

2. hippocampal sclerosis -pathological condition- atrophy or damage of hippocampus

3. Complex focal - impaired awareness, damage in one lobe

4. lamotrigine - antiepileptic medication

# data[].attributes.body
1. reduction in left hippocampal volume - abnormal brain electrical activity cause hippocampal to damage, harden and shrunken

2. no hippocampal sclerosis - no chronic hippocampal damage

3. diagnosed with temporal lobe epilepsy with simple focal, complex focal and secondarily generalised seizures - most common focal epilepsy

4. explained the risk of subsequent seizures and complications of seizure. - possibility injury , impaired memory, cognitive - nature of demonstration and preventive measure

5. treated with lamotrigine - antiepileptic - prevent and control seizure -block Na channel and high voltage dependent Ca channel - cover wide variety of seizure

Final diagnosis

temporal lobe epilepsy with simple focal, complex focal and secondarily generalised seizures