CLINICAL APPROACH

History
• Pre-ictal
• Preceded with aura
• Ictal
• Semiology
• Motor symptoms: Involuntary stiffening or jerky movements of limbs in an awake, unaware or asleep patient
• Sensory symptoms: Blank spells with or without automatisms
• Autonomic symptoms: Urinary incontinence or tongue biting with loss of awareness, or during sleep
• Alteration of mental status
• Duration
• Post-ictal state
• Sleep, headache, hemiparesis

• Family hx of fitting
• Symptoms of infection
• Neurological development
Physical examination

• HOC, length, weight

• Complete neuro examination
• Cranial nerves examination
• Motor examination
• Tone, mass, power, reflex

>>>> Localising neuro signs ; subtle hemiparesis with hyperreflexia

; contralateral hemispheric structural lesion
Investigation
• Blood investigations
• Complete blood count
• Renal function test
• Serum electrolytes

• EEG
• Lumbar puncture
• Imaging
• CT / MRI brain