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75 years old male with gtcs

 75 YEARS OLD MALE

CAME TO THE MEDICINE OPD WITH 

C/C/O:

INVOLUNTARY MOVEMENTS OF UPPER AND LOWER LIMBS (BOTH SIDES) ASSOCIATED WITH FROTHING AND POSTICTAL CONFUSION AFTER THE EPISODE 

HOPI:
The patient was apparently asymptomatic 1 year ago when he developed seizures which was
not associated with aura,tongue biting, involuntary micturition , defecation,.    

    H/O similar complaints in the past 
(Not on any medication).
 NO C/O chest pain, palpitations, shortness of breath, pedal edema, orthopnea, PND.

Not a k/c/o DM,HTN, ASTHMA,THYROID, TB.

PAST HISTORY:

Similar episode (GTCS) , associated with uprolling of eyes and frothing, happened one yr back, during sleep in the night , lasted for 2-3 min, followed by 5minutes postictal confusion , and later on he doesn't remember whatever happened.
They took to near by hospital , gave undocumented medication. No any imaging was done .
Got relieved.

After 6months ,  same episode was repeated.
They Came to our MEDICINE OP, advised few tests, after results , he was given unknown medication and used for 1week.
No any imaging was done .

And now again similar episode for third time.
All these three episodes happened during sleep in the night.

Occupation: 
works ( write records ) in gram panchayat.
He has three sons.
His wife expired 4months back due to high BP, after 1day of admission in nearby hospital.
He lives with his one of the sons.

He is  an ALCOHOLIC, since 35yrs , alternate days almost 100ml a day ,  From last 1yr ,  weekly twice same 100ml a day.

Smokes cigarettes occasionally. 

ALCOHOLIC , LAST BINGE YESTERDAY.

Personal history:

Takes mixed diet
Normal appetite
Adequate sleep
Regular bowel and bladder movements.
No known allergies.
ALCOHOLIC.
SMOKER

No significant family history.

O/E:
Pt is c/c/c
No pallor icterus, cyanosis, clubbing, lymphadenopathy, edema.
Temp:98.5f
Bp: 170/100mmhg
Pr:88bpm
RR: 18cpm
SPO2: 99% RA
GRBS: 145mg/dl

SYSTEMIC EXAMINATION:
CVS: S1S2+
RS: BAE +, NVBS +
P/A: soft, non tender
CNS: 
             RT.         LT
TONE 
    UL      N.            N
 
    LL      N.             N
POWER
  UL.      5/5.         5/5

 LL.        5/5.         5/5
REFLEXES:
           B.     T.       S.      K.      A.      P
 RT.     -.      -.         -.        -.       -.       M

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