A 23yo male has a tonic clonic seizure whilst at college. His GCS is 12, BP=120/77mmHg,
HR=99bpm. What is the most appropriate inv for his condition?
a. CT
b. MRI
c. Serum blood glucose
d. Serum drug levels
answer B......... first time seizure needs to be screened for epilepsy, MRI investigation of choice, blood glucose should be checked but w/o history of DM, decent vitals, its not the most appropriate single option
Definition
• paroxysmal alteration of behavior and/or EEG changes resulting from abnormal, excessive
activity of neurons
• status epilepticus: continuous or intermittent seizure activity for greater than 5 min without
regaining consciousness
Categories
• generalized seizure (consciousness always lost): tonic/clonic, absence, myoclonic, atonic
• partial seizure (focal): simple partial, complex partial
• causes: primary seizure disorder, structural (trauma, intracranial hemorrhage, infection,
increased ICP), metabolic disturbance (hypo/hyperglycemia, hypo/hypernatremia,
hypocalcemia, hypomagnesemia, toxins/drugs)
• differential diagnosis: syncope, pseudoseizures, migraines, movement disorders, narcolepsy/
cataplexy, myoclonus
Minimum Workup in a young person with 1st Time Seizure
CBC and differential
Electrolytes including Ca2+, Mg2+, P04
HeadMRI
Metabolic screening for uremia, hypoglycemia, drug intoxications, and electrolyte disorders should be conducted for patients with first seizure who present to the emergency department.[35] Perform other laboratory investigations as indicated for specific clinical situations.
ReplyDeleteNeuroimaging should be performed, because discovery of an epileptogenic lesion can have an impact on the diagnosis, prognosis, and treatment of new-onset seizures. Chadwick and Smith concluded that plausible arguments may be made for obtaining routine early computed tomography (CT) scanning and reserving magnetic resonance imaging (MRI) for patients with epilepsy whose seizures are not controlled by antiepileptic drugs
therefore metabolic screen is the first thing to do! source: Medscape!
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