Concluded Case

A 21 yrs old male patient presented with h/o fall unconscious on ground followed by muscle contraction of jaw , no h/o up rolling of eye ,tounge bite ,frothing ,fever ,trauma patient gained concious after 2 min but there is H/o post ictal confusion lasted for 1 hr cbc,lft ,rft,rbs -wnl ECG please give differential diagnosis

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Concluded answer

LAHB INCOMPLETE RBBB = BIFASCULAR BLOCK ADV 1 HOLTER MONITERING 2 EEG 3 MRI BRAIN DD 1 EPILEPSY .. 2 BIFASCULAR BLOCK -----> CHB

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H/O LOC followed by tonic spasms Post ictial aura Suggestive of Epilepsy ECG RBBB, otherwise normal Treat with Levetiracetum 500mg BD Take Family history Past h/o any LOC or GTCS Food habits MRI of Brain/MR Angiography EEG TSH,BSL, Lipid profile,RFT, Electrolytes, Bicarbonate 2D Echocardiography DD 1 Primary epilepsy 2 NCC 3 Tuberculoma 4 Glioma 5 Astrocytoma 6TIA 7 SOL brain including vascular tumour 8 Hypoglycemia 9 Myxoedema coma 10 Metabolic dyselectrolytaemia 11 Silent AMI 12 Ureamia My provisional diagnosis is Late onset Epilepsy due to NCC Let report come & confirm diagnosis & treat accordingly.

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As given history Might require EEG for better evaluation Keep under observation Sos imaging if persistent episode Check metabolic components Serum calcium magnesium phosphorous Electrolytes

Ecg Right axis deviation rest NSR TWNL.. Go for MRI brain,, EEG,, s electrolytes,, and neurologist opinion..

LAHB INCOMPLETE RBBB = BIFASCULAR BLOCK ADV 1 HOLTER MONITERING 2 EEG 3 MRI BRAIN DD 1 EPILEPSY .. 2 BIFASCULAR BLOCK -----> CHB

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H/o partial seizure n disoriented state part of post ictal phase.......ecg is wnl

ECG normal

Ecg is WNL Pt most probably suffering from seizure Advise MRI Brain

DDx 1. Syncope (even presence of post ictal confusiom doesn't rule it out) >Orthostatic hypotension >Transient arrythmia 2. Seizure (more likely) Mx 1. EEG P.S The ECG attached is perfectly fine no blocks whatsoever. The only noticeable finding is early repolarization (common in young)

Normal Sinus rhythm

ECG. NAD

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