Neuro Case

3F – MACASARTE, DJ
• 31/M, right handed, chemistry teacher, from Cebu

Patient had upward rolling of eyeballs, frothing of saliva and loss of

consciousness. The attack lasted for 5 minutes. On waking up he could
not remember what happened and there was confusion. These events
were narrated by his wife.
Two weeks ago while taking a nap in the faculty room he had jerking of
the right side of the body then the rigid spasms the left side lasting for 5
minutes. This happened 3x, again he could not remember, His c—
teachers claimed he seemed dazed after the event, looks sleepy and
week.
• At the Neuro OPD the wt was 80 kilos, BP – 160/120’ ; HR 100;
RR=40
• SKIN : warm with scars on the legs an arms
• HHENT ; Conjunctival hemorrhage , slightly yellowish sclera
• : NO other craniofacial abnormalities; ruptured right ear drum
• CHEST and LUNGS: decrease breath sound on the left upper chest.
But equal chest expansion
• CVS: Nu murmur, regular rate and ryhtm. Pulses good and bouncing
• ABDOMEN: GLOBULAT , hepatic edge more than 3 cm , NABS
• No palpable masses, Not tender nor rigid
• GUT ; negative kidney punch, noother banimalities
• EXT; aok Pulses ok
• Neuro exam: Awake, follow commands, oriented to time, place and
person. Normal fundoscopic findings, intact cranial nerves.
Motors: 5/5 all extremities, normal tone
No sensory deficits
DTRs: ++, (-) Babinski
(-) dysmetria / ataxia
(-) incontinence
Supple neck
LEARNING POINTS: By the end of this case the student

• 1. MUST be able to identify , understand what is epilepsy and how it differs from
other paroxysmal disorders.
• 2. MUST know the pathophysiology and how seizures are generated?
• 3. MUST learned the different types of epileptic seizure and epilepsy syndrome.
• 4. MUST differentiate the two terms seizures and epilepsy.
• 5.MUST know what causes the seizures /epilepsy
• 6. MUST know how to approach this case:
a .diagnostics and why
b. therapeutic management
• 7. MUST know he prognosis and consequences of epilepsy.
• 8. MUST know how to help a person with epilesy and what to do during an
attack especially outside the hospital.
What is epilepsy?
Epilepsy is a condition characterized by recurrent epileptic
seizures, unprovoked by any immediate identified cause.
Pathophysiology and how seizures are
generated
Different types of Epileptic seizure
Different types of Epilepsy Syndrome
Differentiate the two terms seizures and
epilepsy
What causes the seizures /epilepsy

Common causes:
• Genetics
• Brain damage
• Brain infection
• Developmental disorders
• Structural changes in the brain
• Alcohol
How to approach this case
a .diagnostics and why
- For diagnosis use Brain imaging:
• CT Scan
• MRI
- Electroencephalogram (EEG)
b. therapeutic management
- If seizure lasted >5 minutes, can use Benzodiazepine acutely for
treatment.
- Daily medication: Anti-epileptic drugs
• Initial: Valproate
• Second line: Lamotigrine
Prognosis and consequences of epilepsy
• Reported 30—70% recurrence over 3 years
- sampling, etiology, seizure type
How to help a person with epilepsy and what to do during
an attack especially outside the hospital.

• Keep other people out of the way

• Clear hard or sharp objects away from the person
• Don’t try to stop movements
• Place person on his/her side to help clear the airway.
• Time the length of the seizure
Guide Questions for this Case:
1. Is this seizure?
- Yes.
 2. What are the differential diagnosis? And how to differentiate one
another?
Salient Seizure Syncope Hypoglycemia Narcolepsy
Features
Loss of consciousness + + + +

Rigid spasms + - - -

Frothing of Saliva + - - -

Upward rolling of + - - -
eyeballs

Jerking on the right + - - -

side of the body
lasted for 5 min
3. How to approach this case?
- The physician must determine first, whether the episode in question is
a seizure.

- For diagnosis use Brain imaging:

• CT Scan
• MRI

- Electroencephalogram (EEG)
4. What is your plan of management?
- If seizure lasted >5 minutes, can use Benzodiazepine acutely for
treatment.
- Daily medication: Anti-epileptic drugs
• Initial: Valproate
• Second line: Lamotigrine

- Epilepsy surgery
- Nerve stimulation
- Keto diet
5. What to do if you see someone with…?
• Keep other people out of the way
• Clear hard or sharp objects away from the person
• Don’t try to stop movements
• Place person on his/her side to help clear the airway.
• Time the length of the seizure