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Loss of consciousness, involuntary movement of arms, legs and trunk

Hi, im a med student and just want to know about seizures. i have a case pres but confused of the differential diagnosis it may have. all i know is it is Generealized seizure and might be absence or atonic. Thank you very much. I hope you ll take time to read and help me. thank you very much! General Data: R.V., 10-year old female, right-handed, from Las Piñas City, Metro Manila. Chief Complaint: Episodes of loss of consciousness History of Present Illness: 6 months prior to the initial consult, RV’s parents reported the onset of sudden involuntary movements of the trunk, arms, or legs of RV. The muscle movements were described as slight, but at other times, they were so violent that she had been known to throw an object in her hand across the room. At other times, the patient just fell to the ground, as the result of a sudden loss of muscle tone . Having hit the ground, the patient would immediately rise to her feet. On one occasion, she severly bruised her head and shoulder by striking a chair and table. The parents did not seek medical consult at this time. 1 month prior to consult, the parents noticed that their daughter appeared to loss consiousness briefly. At the time, she was carrying on a normal conversation, when she suddenly stopped and her gaze became fixed. She was unresponsive. There were chewing movements noted and her right hand appeared fumbling for a shirt button. After approximately half a minute, she regained consciousness and became responsive. Because of this, they decided to bring RV to a neurologist for consult. Review of Systems: (-) fever (-) weight loss (-) malaise (-) loss of appetite (-) jaundice (-) difficulty breathing (-) abdominal pain (-) bowel movement disturbances (-) dysuria (-) bipedal edema Past Medical History: No known allergies to food and drugs. No previous admissions/ surgeries. No previous accidents, nor history of head trauma. Family Medical History: (-) Asthma, epilepsy among relatives Personal and Social History: The patient is currently a Grade 4 student with average academic performance. There are no reported exposures to toxins/ chemicals. Birth and Maternal History: Born full-term via spontaneous vaginal delivery to a then 28-year old mother, G1P0. There were no maternal illnesses. Developmental History: Sits without support at 6 months Walks at 13 months First word (“Mama”) at 9 months Physical Examination: The patient is a well-nourished female, not in respiratory distress. BP: 90/60 HR: 80/min RR: 12/min Temp: 36°C Pink conjunctivae, anicteric sclerae, (-) cervical lymphadenopathy, (-) anterior neck masses Equal chest expansion, clear breath sounds, (-) rales, (-) wheezes Distinct heart sounds , good S1-S2, regular rhythm, (-) murmurs Abdomen flat, soft, normoactive bowel sounds, (-) masses Full, regular pulses, (-) cyanosis, (-) edema, (-) clubbing Neurologic Examination: Mental status examination: Conscious, coherent, follows commands promptly No right-left confusion, no astereognosia, no ideomotor apraxia, no dyscalculia Cranial Nerves: No anosmia, bilaterally Pupils 3mm equal and briskly reactive to light Visual acuity (near): OD 20/20, OS 20/20 No visual field cuts Bilaterally, distinct disc borders, cup to disk ratio of 0.4, no hemorrhages, no exudates, no papilledema Full extraocular movements, no ptosis Intact V1-V3, bilaterally No facial nerve palsy Intact gross hearing, Weber’s midline, (+) Rinne, bilaterally Equal palatal elevation Equal shoulder shrug Tongue midline Motor System: Normotonic extremities, 5/5. No abnormal involuntary movements at the time of examination. Muscle stretch reflexes: +2, Plantar responses are flexor bilaterally, (-) clonus Cerebellars: (-) nystagmus, (-) dysmetria, (-) dysdiadochokinesia Gait and station: Normal gait, able to tandem-walk Meningeals: Supple neck, (-) Kernig, (-) Brudzinski Autonomics: (-) incontinence, (-) Horner’s, (-) abnormal sweat patterns
Asked On : Mon, 29 Oct 2012
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Pediatrician 's  Response
the seizures are like absence seizures… do not seem to be involuntary movements…
if loss of consciousness is longer then it may be like GTC. complex partil seizures often have aura.
Answered: Tue, 30 Oct 2012
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