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

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

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

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

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

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

Final diagnosis

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