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Abstract: The patient in this case was a 55-year-old male who developed seizure convulsions after catching a cold and fever 5 days before admission, manifesting as loss of consciousness, flexion of both upper limbs and extension of both lower limbs with shouting, tongue bite, urinary incontinence, and double eye upturn, etc. In combination with head MRI and EEG, seizures were diagnosed. After admission, the patient was given symptomatic treatment with medication for 8 days. The patient’s symptoms were controlled, and the symptoms such as convulsions and double eye rolling were relieved, and there were no further seizures.
[Basic information] Male, 55 years old
Type of disease】Seizures
Hospital】The Second Hospital of Harbin Medical University
Date of consultation】January 2022
Treatment plan] Oxygen inhalation + medication (sodium valproate for injection, mannitol injection, wake-up call injection, shuxin injection, cefoperazone sodium sulbactam for injection, oxcarbazepine tablets)
[Treatment period] Hospitalization for 8 days, regular review
Treatment effect] The convulsions were relieved and there were no more seizures.
I. Initial interview
The patient, 55 years old, had seizure convulsions after catching cold and fever 5 days before admission, manifesting as loss of consciousness, flexion of both upper limbs and extension of both lower limbs, accompanied by shouting, tongue bite, urinary incontinence, and upturning of both eyes, etc. At present, there were 3 seizures, each lasting about 2-3 minutes in remission, and the consciousness was still blurred after remission, and gradually turned clear after about 10 minutes. During the course of the disease, the patient’s body temperature was high, up to 38.7°C. The family brought the patient to our outpatient clinic and completed a CT examination of the head, which showed bilateral lacunar cerebral infarction, and suggested that the patient be admitted to the hospital for observation with medication and further examination of the cause of the convulsive seizures. The patient and his family agreed.
II. Treatment history
Admission: clear consciousness, body temperature 38.3℃, blood pressure 150/100mmHg, heart rate 97 times/min, respiration 16 times/min, free eye movements, normal muscle tone of limbs, positive neck strength. The patient was given oxygen, blood was collected for blood culture, hematocrit, urine routine, C-reactive protein, calcitoninogen, cranial MRI, EEG and other tests.
The patient’s family was informed of the patient’s condition. The patient had 3 seizures within 6 months, and the clinical presentation was considered to be seizures and the need for antiepileptic drugs, and the family gave informed consent. The patient was then given sodium valproate intravenously for injection, oxcarbazepine tablets orally for antiepilepsy, along with mannitol injection for dehydration, wake-up call injection to protect brain tissue, shuxin injection to improve brain tissue circulation, and finally, the patient was given cefoperazone sodium sulbactam sodium for injection for anti-inflammation.
(Magnetic resonance imaging results)
(EEG results)
III. Treatment effect
After 8 days of treatment, the patient’s bilateral upper limb flexion and bilateral lower limb extension improved, and there was no recurrence of shouting, tongue bite, urinary incontinence, double eye upturn and other symptoms; in addition, through active anti-inflammatory and symptomatic treatment, the patient’s body temperature returned to normal, his mental status was good, and his heart rate and blood pressure returned to stable, and he was discharged from the hospital. The patient was advised to continue to take oral antiepileptic drugs after discharge, and not to miss one dose, otherwise it may lead to frequent seizures or even continuous status epilepticus, and the patient and his family agreed and cooperated. In conclusion, through timely and effective treatment, the patient’s convulsions were relieved and no further seizures occurred.
IV. Notes
We are glad that the patient’s seizures were controlled, but we need to advise the patient to protect the patient from bruises when having seizures after discharge, and to quickly clean up hard objects around him; do not forcefully restrain the patient’s convulsing limbs, and do not shake and move the patient at will to avoid fractures and muscle strains. In addition, patients should be reminded to avoid working at height, dangerous sports such as driving, water skiing and diving, and to maintain a healthy and regular life, avoiding strain, lack of sleep, overeating and excessive mental stress.
V. Personal insight
Seizures have several different manifestations according to the type of seizure, the patient in this case belongs to the typical grand mal seizure, some patients can have other types of seizures, such as aphasic seizures, partial seizures, partial seizures secondary to grand mal seizures, which can be manifested as only dazed, only limb shaking without loss of consciousness, or even only dizziness, etc. People with previous history of epilepsy need to pay extra attention and seek medical attention in time for the above cases to avoid The patient should seek medical attention in time to avoid delaying the condition.