15 years old boy with one episode of generalised tonic seizure followed by altered sensorium and fever. (history of RTA one week back and CT Brain done after accident was normal). o/e patient was drowsy and arousable. no focal deficit or neck stiffness Hb 12.1,TLC 21500,Platelet 2.2lakh, sodium 116, K 3.9, RBS 118 mg/dl following is the CT Brain after seizure episode


1. With history of trauma and seizure, counts of 21500, clinical diagnosis of meningitis secondary to csf leak looks tempting; ask for history of csf rhinorrhea and look for basal skull fracture (cribriform plate) on bone window and do lumbar puncture 2. Hyponatremia secondary to raised ICP can be a cause or effect 3. On closure look, bilateral parietoccipital white matter looks relatively hypodense so PRES can be a possibility( check blood pressure)@Dr. Keerthi Reddy

@Dr. Nihaal Reddy images look like PRES; Whats your opinion?

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Subdural haematoma or possibly fracture cribriform plate infection entering through the same

Do L. P. Keep seizures free. Observation Is important.

First u go for MRI BRAIN to R/O intra cranial infection hyponatremia is the Couse of altered sensorium

Such presentation rule out central venous thrombosis .hyponatremia shd be treat with 3% Nacl .


DD CNS infection Hyponatremia Epilepsy

accelerated junctional rythm with LVH??

Hyponatremia z cause of seizure

CT report of this patient

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