Related Cases:
|Case #1 Potassium
|Case #2 Calcium
|Case #3 Calcium
|Case #4 Glucose
|Case #5 Shakes
|Case #6 Weakness
|Case #7 Headache
|Case #8 Weakness
|Case #9 Weakness
|Case #10 Weakness
|Case #11 Weak face
|Case #12 Weak eyes
|Case #13 Shakes
|Case #14 Confusion
|Case #15 Headache
|Case #16 Breathless
|Case #17 Unconscious
|Case #18 Breathless
|Case #19 Weakness
|Case #20 Breathless
An 84-year-old gentleman retired editor collapses whilst in church. He then has what seems to be a seizure with twitching down the right side which settles by the time the paramedics arrive. His Oxygen saturation 99% and BP is 100/80 mmHg. He is unresponsive. He is brought to the ED . Soon after arriving, he starts having further seizures which appear tonic-clonic affecting the right side. He had a previous stroke 4 months ago which left him with a right sided weakness and this is the first time he has been out since.
What actions would you perform
What do you think the cause of his seizures ?
The next morning he is awake and talking and has returned to his baseline. he has little memory of the event. What would your plans be
If he had off deteriorated with worsening lactate or oxygenation what might you have considered.
References
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Case #13 Shakes
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He has a raised lactate of 4 but this settles with supportive care. It transpires that he had a stroke 4 months ago and had a left frontal infarct. The evolved old infarct is seen on a CT scan. It is likely this is a post-stroke seizure. In the meantime, as he had 2 seizures in quick succession, he is loaded on Phenytoin 20 mg/kg given slowly over 1 hour. He settles after the lorazepam and phenytoin and is moved to the ward.
If the seizures had not quickly settled then it would have been wise to discuss with Clinical Care outreach for HDU a Level 2 bed for some ongoing close assessment and monitoring. However, in this case it was felt that his care needs could be met on the acute assessment unit.