55 year old woman with seizures

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 A 50 year old housewife from Valligonda presented to our opd  with the complaints of 

1 episode of loss of consciousness 3 days back 


She studied till her 4th grade and got married to a farmer at the age of 17 years. She gave birth to 4 children via normal vagina delivery and got operated for hysterectomy around 25 years back. Her elder son is unemployed and is an alcoholic where as the younger son is a daily wage laborer. Both of her daughters are married.  

On further questioning her brother revealed that the patients behavior has changed ever since she got married.

Her brother reveales his brother in law to be an abusive husband. He says his brother in law often beats her so much to an extent that she would often have nose bleeds. She  covers her bruises and takes pain killers frequently for the pain. 

On a daily basis, both the husband and wife quarrel alot. She has become an aggressive individual herself and often bears her children. She shouts at her children and son in laws frequently. 

Her brother reveals that during arguments she has this typical behavior of pulling her hair and biting them.

He also reveals that she has been stressed lately as her elder son is unemployed and has been drinking alcohol frequently and because of frequent arguments at home he left their house in search for a job. She even isn't on good terms with both her son in laws who consume alcohol frequently and argue back with her. 

15 days back her younger daughter gave birth to a baby boy and has been staying at their place ever since. Since then she has been having heated arguments with her daughter and son in law asking her daughter to change her husband's behavior and habits.


3 days back while sitting on a chair and eating a papaya and having a casual conversation with her husband, she suddenly had a loss of consciousness lasting for 5 minutes. After regaining consciousness she was given a glass of water with sugar. She herself got up and got ready to go to the hospital.


She was taken to a local hospital where in they were told that she was a hypertensive and had hypothyroid as well. 

She was given IV fluids along with Tab Telma AM and Multivitamins. 


At around 4pm at our OPD, her brother tells us that she had another episode of loss of consciousness  and  micturated in her clothes after which she was rushed to casualty. At the casualty she had involuntary movements of her right upper and lower limb along with uprolling of eyes.

She was given 2 injections and was shifted to ICU.


On presentation to ICU, 

She is conscious and not answering questions though has been involving in conversations with her brother 

Her 

PR - 95 bpm

BP - 140/80

Afebrile

CNS

She is conscious 

Reflexes could not be elicited 

Cvs - S1,S2 +

Lungs are clear on auscultation

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