General Medicine : 57 yr old male patient

57 year old male patient 

NOTE

This is an ongoing case and will be updated .

The reference link (if any) will be mentioned at the bottom.

Date of admission: 27/10/21



HISTORY OF PRESENT ILLNESS-  
The patient 
A 50 yr old male from West  Bengal presented to the causality with complaints of -

1.Sudden loss of consciousness (black outs). 

2.sometimes there is involuntary movements of both upper limb and lower limb during the blackout. 

3.The loc after waking is usually associated with right unilateral head pain after waking up. 

4.He also has no recollection of the incidents on waking. 



  • Patient was apparently asymptomatic 32 years back when he had loss of consciousness while lying on the bed at night not a/w involuntary movements . 
  • Since then he had several episodes of LOC sometimes a/w involuntary movements (approx 2-3 or more times per month) (diagnosed as epilepsy by the doctors). Almost always a/w U/L head ache.
  • He at times has hard falls leading to fall of teeth(3 upper incisors and a canine) once, lacerations, contusions on the body.
  • Involuntary movements - sometimes a/w frothing, not a/w tongue bite, involuntary micturition, involuntary defecation. 
  • They consulted a few doctors but they found no improvement. One of them gave an unknown medication. One gave a sleeping medication which only made him sleep but no improvement in his main problem. 
  • Before a year back they consulted a neurophysician, he gave PHENYTOIN SODIUM 100mg which helped reduce the frequency of the LOC episodes AND 
  • the U/L head ache , that he usually has after waking up from the episode has also reduced. 
  • A MONTH back without him knowing he removed his clothes and ran for a bit when his wife and brother saw him and got him back home. After this episode when consulted the same doctor, increased the dose to 300mg. 
  • Recently, since after that episode, he has difficulty in raising both upper limbs above the shoulder and has action tremors.
  • Life events- 
  • BIRTH- milestones achieved all normal. 
  • 18years of age- First episode of LOC. A few months later, first episode of EPILEPSY during the blackout. 
  • 18yrs- NOW- several episodes of LOC(2-4 per month) sometimes Epileptic episodes during the blackout with post-ictal weakness. And right u/l headache after the episode. 
  • ONE YEAR BACK- Doctor prescribed  PHENYTOIN SODIUM 100mg(OD)- reduced frequency and symptoms of blackouts.
  • ONE MONTH BACK- The unconscious clothes removal episode after which the dose increased to 300mg(OD)
  • The patient wants a low morbidity life since these falls are very frequent and occur without any prior symptoms predisposing him to high danger to life. And he also doesn’t want to be on life long medication for the same.

PAST HISTORY       

  •   K/c/o EPILEPSY
  • no history of  diabetes , CAD ,asthma
  • no history of surgeries, radiation ,blood transfusion

PERSONAL HISTORY:
  • Married
  • Occupation : service govt job
  • Diet: mixed. ( Non vegetarian)
  • Appetite:  normal
  • Sleep: Adequate
  • Micturition: Regular
  • Habits/ addictions
  • Alcohol - occassionally
  • Non Smoker
  • Chews supadi everyday since 35 yrs
FAMILY HISTORY:

NOT SIGNIFICANT

GENERAL EXAMINATION:
  • Patient is conscious, coherent, co-operative.
  • He is well oriented to time, place and person. 
  • He is thin built. 
  • Pallor - absent
  • No icterus
  • No cyanosis
  • No clubbing
  • No lymphadenopathy
  • No Edema.
VITALS 

BP-110/70 mm hg

PR-83 bpm

RR- 17 cpm

SPO2-98% on RA

Systemic examination

CVS EXAMINATION

  • CVS-S1S2 heard 
  • RS- NVBS +
  • P/A- soft, non tender
CNS- 
  • Pt is c/c/c
  • Speech - normal
  • No cerebral signs 
  • No meningeal signs
  • Tone- 5/5 both UL AND LL
  • Power- 4/5 both UL
  • 5/5 both LL
  • Sensory system- normal 
  • Cranial nerves - normal
  • GCS- 15/15
CLINICAL FINDINGS- 

Action tremors- 


HURT DURING FALLS- 






INVESTIGATIONS- 







ECG- 




CHEST X-RAY- 



DIAGNOSIS- 

PERIARTHRITIS OF SHOULDER WITH K/c/o EPILEPSY


TREATMENT- 

T. PHENYTOIN SODIUM 100mg PO/OD

T. ZINCOVIT PO/OD

T. FLUPIRTIN P PO/OD

T.PAN 40mg PO/OD

PHYSIOTHERAPY OF SHOULDER 

Reference link : https://moulika99.blogspot.com/2021/10/blackouts-causing-morbidity-in-day-to.html


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