43 year old with LOC associated with tonic clonic movements of hands and loss of memory

43 years old labourer by occupation came with c/o loss of consciousness associated with tonic clonic movements of hands and loss of memory of the episode suggestive of seizure.

No h/o tongue bite, frothing. 

Following this episode, she went to local hospital where she was found to have high BP recording and was given TAB. ATENOLOL.

H/o heartburn, regurgitation (burning sensation in throat), dyspepsia, belching , flatulence since 4 years suggestive of GERD. 

Currently using medication (ranitidine, aluminium magnesium syrup), domperidone) for the same.

C/O nausea since yesterday. 

C/O giddiness since yesterday.

C/O headache (more in the frontal and temporal areas)since yesterday. 

She has myopia for which she has been using spectacles (on and off) since last year.

No h/o loose stools, burning micturition.

No h/o palpitations, Dyspnea, chest pain.

No h/o vomitings.

No h/o cold, cough, fever.

H/o fall 20 years ago which resulted in lateral dislocation of left knee. Did not take any treatment for the same.

H/o fall 9 months ago while walking which resulted in fracture of left tibia following which nailing was done. 

PAST HISTORY: 

Not a K/C/O DM, HTN, TB, BA, Epilepsy, CAD, CVA.

FAMILY HISTORY: Not significant

MENSTRUAL HISTORY:

Hysterectomised 7 years ago in view of fibroid.

MARITAL HISTORY: 

28 years marital life, P3L3A1

PERSONAL HISTORY:

Diet- Mixed

Appetite- normal

Sleep- inadequate

B&B habits- regular

Occasional toddy drinker 

GENERAL EXAMINATION:

She is conscious, coherent, cooperative, well oriented to time, place, person. She is moderately built and moderately nourished.

No pallor, icterus, cyanosis, clubbing, lymphadenopathy, Edema

Vitals: 

Temperature- Afebrile

BP- 

220/100 mm Hg (on admission)

120/90 mm Hg (14/12/21)

 PR- 76 bpm

 SpO2- 98% @ RA

             

Systemic Examination:

CVS- S1,S2 sounds heard

RS- BAE +, NVBS heard

P/A- Soft, non tender, Bowel sounds heard

CNS- 

At admission: GCS- E2V3M4

                                        R                   L

Tone.     UL               Reduced        Normal

               LL                Normal          Normal

Power-                    Not elicited

Reflexes-               Exaggerated     Normal

Plantar-                  Withdrawal        Flexor

No signs of meningeal irritation 

Cerebellar signs- Not elicited 

INVESTIGATIONS:

ECG:

2D ECHO:

USG Abdomen: shows Grade-I Fatty Liver

CT BRAIN:

Treatment-

1. Inj. LABETALOL 10 mg I.V./STAT

2. TAB. AMLONG 5 mg STAT

3. TAB. PAN 40 mg PO/ OD

4. TAB. ULTRACET

5. Ophthalmology referral was done in order to rule out hypertensive retinopathy

PROVISIONAL DIAGNOSIS:

Hypertensive Urgency