A 62 year old Male, c/o 4-5 episodes of involuntary movements of both upper limbs and lower limbs since morning on 20/10/2022.

Chief complaints: Pt c/o involuntary movements since morning 6-7 episodes since morning . 
c/o uprolling of eyes. 
HOPI: Pt was apparently asymptomatic till morning. Then he had an episode of involuntary movements of both UL and LL at 6:30AM on 20/10/2022,which lasts  for 4-5 minutes with up rolling of eyes. Not ass with vomiting, involuntary micturition, defecation and no post ictal confusion. 
No froathing,no tongue bite during the episode. 
He had 5-6 similar episodes till afternoon .
No developmental delay. 
Past history:
K/c/o HTN since 4-5 years
Not a k/c/o DM, HTN, ASTHMA, CAD.
No history of similar complaints in the past. 
H/o surgery 4months back for? Intestinal ulcer and he stayed in hospital for 20 days. 
Personal history:

Diet- mixed
Appetite-normal
Bowel and bladder movements- regular.
Addictions- He used to consume 90ml of whisky per day for the past 40 years. But he stopped consuming it 4 months back. 
Allergies- none
General examination:

Patient is conscious, coherent and cooperative. Well oriented to time, place and person.
Moderately built and moderately nourished.
No pallor, icterus, cyanosis, clubbing, lymphadenopathy, edema.
Vitals:


Temp- 98°F
BP-130/90MMHG
RR-18CPM
PR- 68BPM.
GRBS-549mg/dl on the day of admission. 
Spo2 - 100%

Systemic Examination:

CVS: S1,S2 Heard

      No Murmurs 

RS: B/L Normal Vesicular Breath Sounds Heard. 

P/A: soft, non tender. 


CNS EXAMINATION:

Higher functions:
Right handed 
Conscious 
Oriented to time ,place and person 
Memory: recent- present 
              Immediate: present 
              Remote: present 
Speech:
           Normal 
No delusions or hallucinations 

Cranial nerve examination:
I- Olfactory nerve-  sense of smell present 
II- Optic nerve- direct and indirect light reflex present
III- Oculomotor nerve, IV- Trochlear and VI- Abducens- no diplopia, nystagmus or ptosis
V- Trigeminal nerve- Masseter, temporalis and pterygoid muscles are normal. Corneal reflex is present.
VII- Facial nerve- face is symmetrical, able to do forehead wrinkling 
VIII- Vestibulocochlear nerve- no hearing loss
IX- Glossopharyngeal nerve. X- Vagus- uvula not visualised
XI- Accessory nerve- sternocleidomastoid contraction present
XII- Hypoglossal nerve- Movements of tongue are normal, no fasciculations, no deviation of tongue

Spinomotor:

                     Right                Left 

Bulk:  U/L  
     arm :  normal                 Normal 
 Forearm: normal                 Normal 
           L/L:       
  thigh: normal                  Normal 
      Leg: normal                Normal 

Tone:        U/L:   Normal            Normal 
                  L/L:   Normal            Normal 

Power: 
         U/L
                Hand :    4/5                     4/5 
               Elbow:    4/5                     4/5
          Shoulder :   4/5                     4/5
        L/L
                 Ankle:   4/5                     4/5 
                 Knee:    4/5                     4/5
                   Hip:     4/5                     4/5 

Reflexes:
          Biceps:        -                             -
          Triceps:        +                            +
         Supinator:     +                             +
         Knee:             +                             +
         Ankle:           +                              +
         Plantar:    Flexion               Flexion
Sensory system :   
 crude touch :       Present       present fine touch  :        Present         present    pain         :       Present            present
  vibration :        Present           present  temperature :       Present        present   stereognosis:      Present         present 2 point discrimination:   present         present
graphaesthesia:    Present     present 

Coordination; present 
GAIT :NORMAL
Investigations:
HBA1C:
LFT:



Serology: Negative for HIV, HBS Ag, Anti HCV antibodies. 

DIAGNOSIS:
FOCAL SEIZURES WITH DYSCOGNITION, DENOVO DM2 WITH UNCONTROLLED SUGARS. 


Treatment:
1.INJ LEVEPILL 500 mG / IV /BD
2.INJ. LORAZ 2CC / IU /S0S 
3.INJ • OPTINEURON 1 AMP IN 100 ML NS /IV/OD
4.INJ. HAI SC / TID / A/c to GRBS inform 
INJ. NPH SC/BD
5) INJ. PAN 40 mg IV / OD/ BBF. 
6) GRBS MONITORING. 
7) 3-4 EGG WHITES/DAY.
8) MONITOR VITALS
9) INFORM SOS. 

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