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Having extreme internal freezing spells, tachycardia and drowsiness. CT scan of the brain showing possible stroke, MRI showing seizure activity

i HAVE A PATIENT WHO IS 81YRS OLD, FAIRLY HEALTH AND ACTIVE, DIABETIC, WHO IS EXPERIENCING EXTREME INTERNAL COLD/FREEZING SPELLS. SHE HAD A HEAD CT SHOWING POSSIBLE STROKE , MRI RESULTS LEAN TOWARD POSSIBLE SEIZURE ACTIVITY. AN EEG WAS JUST DONE BUT NO RESULTS YET. WHEN SHE IS HAVING AN EPISODE SHE WILL BECOME TACHICARDIC, CONFUSED AND THEN DROWSY. SHE DENIES PAIN OR SOB. IS THIS AN UNUSUAL EXAMPLE OF SEIZURE ACTIVITY OR DO YOU HAVE ANY OTHER DIFFERENCIAL DIAGNOSIS?
Asked On : Sat, 18 Aug 2012
Answers:  1 Views:  39
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Internal Medicine Specialist 's  Response
Dear freind, welcome to HCM .
a well asked query indeed !
it lookjs like a seizure with sympathetic overactivity, and post ictal state like drowsiness.
does she periodically get better?
does the MRI show an infarct/ diffusion restriction?
how long back was the onset of episode?
any paresis?
you can give iv midazolam under preparedness, under competent medical supervision and see if it aborts the episodes, confirming the seizure. EEG may / may not show it.
pl. take a neuro consult, if you are not able to decide further.
pl. post the results and greater details of the entire illness and would be glad to revert back.
she should be in an ICU.
Good luck.
Answered: Sun, 19 Aug 2012
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