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
LAHB INCOMPLETE RBBB = BIFASCULAR BLOCK ADV 1 HOLTER MONITERING 2 EEG 3 MRI BRAIN DD 1 EPILEPSY .. 2 BIFASCULAR BLOCK -----> CHB
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.
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
Look for electrolyte disbalance mainly calcium and a prophylactic eeg and put pt. On conservative anticonvulsant until diagnosis is confirmed
Ecg Right axis deviation rest NSR TWNL.. Go for MRI brain,, EEG,, s electrolytes,, and neurologist opinion..
Ecg within normal limits.. better to get eeg done.. may b a case of focal seizures
H/o partial seizure n disoriented state part of post ictal phase.......ecg is wnl
ECG normal
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)
LAHB INCOMPLETE RBBB = BIFASCULAR BLOCK ADV 1 HOLTER MONITERING 2 EEG 3 MRI BRAIN DD 1 EPILEPSY .. 2 BIFASCULAR BLOCK -----> CHB
ECG is normal, probably brain pathology. Transient arrhythmia a possibility.
Cases that would interest you
- Login to View the image
18 year young male presented to emergency opd with unconsciousness since 3 days and dilated pupil(3mm). h/o severe headache and blurred vision and vomitting. what is your diagnosis?? treatment plan??
Dr. Niket Mantri9 Likes18 Answers - Login to View the image
15 years male with H/o recurrent episodes of seizures. Comments Plz..
Dr. Ravikanth Moka3 Likes18 Answers - Login to View the image
around 35 yrs old male pt admitted with h/o. New onset of seizures and status epilepticus.. 1. what are the clinical findings? 2 .x ray findings. 3.ecg findings. 4. CT BRAIN ..plain and contrast findings. . 5. With correlation of all these findings what will b the most suitable final diagnosis? plz share ur views. ..Thanks in advance. ..
Dr. Suresh Narayanan8 Likes31 Answers - Login to View the image
A 50-year-old male nuclear power plant worker with an unremarkable medical history presented with complaints of recurrent headaches, nausea, and vomiting with left-sided facial droop and personality changes, all occurring for 3-4 weeks. A CT scan of the brain showed a right frontal mass. What it shows?
Dr. Sushil Mishra2 Likes15 Answers - Login to View the image
65 yrs male presented to my OPD with H/o GTCS 2 episodes with in last 1month.no visual field defect.pituitary hormones report awaited.please give diagnosis and management plan
Dr. Vijay Kumar Gupta1 Like16 Answers
5 Likes