A 30 year old male came to casualty with chief complaints of seizures 2 days back
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Chief complaints:-
Episodes of seizures 2 days ago with loss of consciousness and vomiting.
History of presenting illness:-
Patient was apparently asymptomatic 2 days back then he had an episode of vomiting and felt weak, after sometime he had an episode of seizure which lasted for 2 to 3 minutes and was associated with loss of consciousness, up rolling of eye ball, frothing, tonic-clonic movements of upper limb and lower limb, he also felt confused after the episode of seizure and had no recollection of events. After 10 to 15 minutes of seizure he had an another episode of vomiting. He was then brought to kamineni hospital.
Patient had a similarly history of seizure 1 year back.
Patient is a chronic alcoholic form past 7 years, he daily consumes 360ml per day.
Patient was a daily wage worker where he carries heavy loads and consumes alcohol after work to get rid of his tiredness.
Patient had experienced sleep disturbance, restlessness and tremors when he did not consumes alcohol.
- 2 days before seizure, he was not feeling well so he did not consumes alcohol and also his appetite was decreased.
- no history of headache and blurring of vision.
- no history of chest pain , SOB, palpitations.
Past history:-
He had a similar episode of seizure 1 year back and was taken to local hospital.
He was a chronic alcoholic from past 7 years.
No history of hypertension, diabetes, asthma, TB.
Personal history:-
Diet - mixed
Appetite - decreased
Sleep - adequate
Bowel and bladder movements - regular
Habits - chronic alcoholic since 7 years .
Family history:- patient’s father was also a chronic alcoholic.
General examination:-
Patient is conscious, coherent, uncooperative and well oriented to time, place and person
Moderately built and moderately nourishment.
BP - 130/90
PR - 86 bpm
RR - 20 cpm
Temperature - afebrile
No pallor, icterus, cyanosis, clubbing, lymphadenopathy and oedema.
Systemic examination:-
- CVS:- S1, S2 heard and no murmurs.
- RS :- B/L NVBS
- per abdomen:- soft , no tenderness and no palpable mass.
- CNS:- conscious, coherent, uncooperative and patient is drowsy.
*speech is normal
* cranial neves - all cranial nerves are intact
* sensory system- normal
* motor system:-
Right Left
Bulk -inspection N N
-palpitation. N. N
* reflexes:-
Right. Left
-biceps +2 +2
- triceps +2 +2
- supinator +2 +2
- knee +2 +2
- ankle +2 +2
- plantar Flexor. Flexor
* GAIT - normal
Dysdiadochokinesia :-
Provisional diagnosis:-
Seizures secondary to alcohol withdrawal.
( alcohol dependence syndrome)
Investigations:-
Hb - 10.9
TLC - 3000
PLT - 1.3
RBS - 134
Trop I - 1.5
LFT:-
TB - 1.84
DB- 0.82
AST - 62
ALT - 24
TP - 7.0
A/B - 4.1
A/G - 1.41
RFT:-
Serum urea - 14
Creatinine- 0.7
Na+ - 130
K+ - 4.7
Cl- - 102
Phosphorus - 3.3
CUE:-
Alb - +
Sugar - nil
ECG:-
Ultrasound report:-
No abnormalities detected 
2D ECHO:-
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