CASE PRESENTATION

GENERAL INFORMATION

• PATIENT: QM
• AGE: 25
• GENDER: FEMALE
• CIVIL STATUS: SINGLE
• RELIGION: ROMAN CATHOLIC
• ADDRESS: B5 L12 CAIMITO ST. PUROK SUMULONG
DELA PAZ CITY OF ANTIPOLO RIZAL
• OCCUPATION: SERVICE CREW IN MCDONALDS
• DATE OF BIRTH: 12/16/1994
 CHIEF COMPLAINT

• SEIZURE
 HISTORY OF PRESENT ILLNESS

• 9 HOURS PRIOR TO ADMISSION PATIENT HAD

HEADACHE, NO IDENTIFIABLE PRECIPITATING
FACTOR, TEARING IN CHARACTER, NON RADIATING
WITH A PAIN SCALE OF 8/10. NO RELIEF NOTED, ALSO
HAD 1 EPISODE OF VOMITING AFTER WHICH THERE
WAS STIFFENING OF BOTH UPPER AND LOWER
EXTREMITIES, UPWARD ROLLING OF EYEBALLS
LASTING 10 SECONDS AND LOSS OF CONCIOUSNESS
FOR ABOUT 30 MINUTES. 3 MORE EPISODES OF
STIFFENING OF UPPER AND LOWER EXTREMITIES
OCCURRED, HENCE BROUGHT TO ER AND WAS
ADMITTED.
 PAST MEDICAL HISTORY

• (+) GENERALIZED ONSET MOTOR TONIC CLONIC

SEIZURE – LEVETIRACETAM 500MG/TAB – NON
COMPLIANT
• (-) HYPERTENSION
• (-) DIABETES MELLITUS I AND II
• (-) PTB
PERSONAL AND SOCIAL HISTORY

• NON SMOKER
• NON ALCOHOLIC DRINKER
REVIEW OF SYMPTOMS
REVIEW OF SYMPTOMS
 PHYSICAL EXAMINATION

GENERAL SURVEY
• BP: 110/70 • ANICTERIC SCLERAE, PINK
PALPEBRAL CONJUNCTIVAE,
• PR: 60BPM SUPPLE, (-) NECK VEIN
• RR: 30CPM ENLARGEMENT, (-) CAROTID
• T: 37 BRUIT, SYMMETRICAL
CHEST EXPANSION, CLEAR
• O2 SAT: 96% BREATH SOUNDS,
ADYNAMIC PRECORDIUM,
NRRR, FLABBY, NORMOTIVE
BOWEL SOUNDS, FULL
EQUAL PULSES
 NEURO-EXAM

MSE CN
• DROWSY, EASILY • I – ABLE TO SMELL
• II – VF INTACT(-)
AROUSABLE TO NAME HEMORRHAGES/PAPILLEDEMA
CALLING, ORIENTED TO • II – III – 2-3MM ENRTL, (+)
TIME, PLACE, PERSON, ACCOMODATION
INTACT • III,IV,VI – PRIMARY GAZE
MIDLINE, NO PTOSIS
COMPREHENSION AND • V – VI V3 INTACT, GOOD
CONCENTRATION, MASSETER
FOLLOWS 2 STEP • VII – NO FACIAL ASYMMETRY
COMMANDS • VIII – INTACT GROSS HEARING
• IX - X – UVULA MIDLINE
• XI – GOOD SHOULDER SHRUG
• XII – TONGUE MIDLINE
LABORATORIES REQUESTED
LABORATORIES REQUESTED
 DIAGNOSTICS INITIAL

• CRANIAL CT SCAN WITH CONTRAST

• CHEST XRAY
• ECG
• EEG
GENERALIZED TONIC
CLONIC SEIZURE
 OBJECTIVES

• DEFINITION
• CAUSES
• SYMPTOMS
• DIAGNOSTICS
• TREATMENT
 DEFINITION

• THIS INVOLVES THE ENTIRE BODY

• CALLED AS “GRAND MAL SEIZURE”
• TERMS LIKE SEIZURE, CONVULSION, OR EPILEPSY
ARE MOST OFTEN ASSOCIATED WITH GENERALIZED
TONIC CLONIC SEIZURE
 CAUSES

• THE SEIZURES RESULTS FROM OVERACTIVITY OF

THE BRAIN
• THIS OCCURS IN ANY AGE
• OCCURS ONCE USUALLY SINGLE EPISODE OR CAN
OCCUR AS PART OF A REPEATED, CHRONIC ILLNESS
(EPILEPSY)
 SYMPTOMS

DURING
• PEOPLE USUALLY HAVE • BITING THE CHEEK OF
AURAS (BEFORE SEIZURE TONGUE
THEY HAVE VISION, TASTE,
SMELL, OR SENSORY • CLENCHED TEETH OR
CHANGES, JAW
HALLUCINATIONS, OR • LOSS OF URINE OR
DIZZINESS)
STOOL INCONTINENCE
• RIGID MUSCLES
• STOPPED BREATHING
• VIOLENT MUSCLE
CONTRACTION • BLUE SKIN COLOR
• LOSS OF CONCIOUSNESS
 SYMPTOMS

AFTER
• CONFUSION
• DROWSINESS OR SLEEPINESS THAT LAST FOR 1 HR
OR LONGER (POST ICTAL STATE)
• LOSS OF MEMORY ABOUT THE SEIZURE
• HEADACHE
• WEAKNESS OF 1 SIDE OF THE BODY