85 year old male with seizures

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An 85 year old male came with complaints of :

• Stary look and frothing from mouth followed by up rolling of eyeballs since 3:30 in the afternoon.
• Thick secretions from mouth since 3 days

History of present illness :

Patient would manage business in his early years of life and then he was addicted to alcohol because of which he couldn’t continue his work. 

According to his daughter since 10 years he hasn’t been able to remember anything he was told and hence he stopped doing business and would stay at home. He stopped consuming alcohol since then. He wasn’t able to do his regular chores. He would eat when fed and sleep all day.

3 years back he developed tonic movements in upper and lower limbs for 30 minutes associated with frothing from mouth. Involuntary micturition and passage of stools was present during the episode. The episode was associated with postictal confusion. 

He was taken to hospital and used unknown medication for 2 years. (?hyponatremic seizures)

Today afternoon he developed starry look and frothing from mouth associated with up rolling of eye balls.

No h/o LOC or vomiting.

No involuntary micturition or passage of stool in this episode.

Past history :

Not a K/C/O DM, HTN, TB.

Vitals :

Temp : afebrile

PR : 82 bpm

RR : 18cpm

BP : 110/90 mm Hg

SpO2 : 99%

General examination :

Patient was stupurous

No pallor, icterus, cyanosis, clubbing, lymphadenopathy

Systemic examination :

CVS : S1 S2 +

RS : BAE +

P/A : Soft, Non tender

CNS :

Speech : Normal

No signs of meningeal irritation

Tone :              R.              L.     

UL                   N              N

LL                     N              N

Power :              R.              L.     

UL                    5/5             5/5

LL                    5/5             5/5

Reflexes : Slightly exaggerated  biceps, triceps, supination, knee, ankle reflexes in both limbs. (3+)

Provisional diagnosis :

Seizures with ?left acute ischemic stroke in frontal and occipital lobe

Investigations :

Treatment:

Inj OPTINEURON 1 amp in 100ml NS IV/OD

Inj LEVIPIL 500 mg IV/BD

Neb with MUCOMIST TID