History of present Illness Dr. XYZ is

History of present Illness Dr. XYZ is a 59 years old physician who visits his brother, also a physician, while vacationing one summer in Northern parts of Pakistan. He verbalizes “My wife has told me that the she has noted seizure activity in me. My clinical manifestations were subtle at first but have become more disturbing lately. The last time I had an episode I would have fallen down a flight of stairs if she hadn’t caught hold of me. She tells me that during one of these things, I don’t respond to anything but I do not lose consciousness either. She says that I just stare off into space and fidget with my tie or the buttons on my shirt. I don’t respond to my surroundings and don’t seem to know what is going on at all, that I’m not in the present. It has been going on now for about three weeks and the episodes last three or four minutes every time. At first it was every three days; now, it’s every other day. When I come out of it, I’m extremely confused and unable to speak clearly for some time. I try to talk but, apparently, my words are incoherent. I remember very little about the attacks. I do remember several things, however, especially, the taste of that seems like soap in my mouth. Immediately before I black out, I feel some mild stomach discomfort. And when I do become aware again, I feel a distinct sense of loss of time and sometimes I’m so exhausted that I need a nap.” The patient’s brother strongly encourages him to see a neurologist as soon as possible and volunteers to refer him to a good specialist and make an appointment. Past Medical History ï‚· Malignant melanoma on lower back removed 14 years ago ï‚· Two colonic polyps removed 7 year ago during colonoscopy ï‚· Diverticulosis X 4 years ï‚· Occasional back pain ï‚· Tension headaches Family History ï‚· No family history of seizure disorder, cancer, or cardiovascular disease ï‚· Mother died from tuberculosis at age 69 ï‚· No information available for father ï‚· One brother; age 54, is alive and well Social History ï‚· Married for 39 years, lives with his wife who is a nurse, and has 2 daughters who are in good physical health ï‚· A business man ï‚· Has a positive history of alcohol use but states that “he hasn’t had a drop in 20 years” ï‚· Non smoker ï‚· Works out 3 -5 times per week at the gym and jogs most mornings ï‚· Eats healthy and is conscientious of calories, fats and sugars Review of Systems ï‚· Recently has noticed a decrease in stamina and tires easily ï‚· (-) for head injury, increase in frequency or change in nature of headaches, nausea, vomiting, visual or other sensory changes, irritability, hemiparesis, TIA, tingling or numbness, HIV disease, history of febrile seizures, problem with balance, and identifiable triggers of attacks ï‚· Patient’s interview details and his overall score on the Quality of Life in Epilepsy Questionnaire (QOLIE – 31, see Appendix G) show that seizures are beginning to impact significantly on his quality of life; however, his overall scores on energy/fatigue, pain, and social support domains are high in comparison with a cohort of other patients with recurrent seizure activity. Medications ï‚· Multiple vitamin 1 table po QD ï‚· Denies any herbal products ï‚· Occasional acetaminophen for headaches and back pain Allergies ï‚· Not Known ï‚· Dogs ïƒ itchy eyes and sneezing Physical Examination and Laboratory Test General ï‚· Patient is cooperative, oriented, and appears to be his stated age, but seems tired Vital Signs See Patient Case Table 40.1 Skin ï‚· Warm, soft, dry, and non-jaundiced ï‚· (-) for rashes, buries, and other lesions ï‚· Hair quality, distribution, and texture unremarkable Head, Eyes, Ears, Nose, and Throat ï‚· PERRLA ï‚· EOMI without nystagmus ï‚· Optic disc margins appropriately sharp ï‚· Wears eyeglasses ï‚· TMs pearly gray, revealing good cone of light bilaterally ï‚· Nasal mucous membranes moist ï‚· (-) for erythema of pharynx and oral ulcres Nexk/Lymph Nodes ï‚· Neck supple without stiffness ï‚· (-) for adenopathy, bruits, JVD, and thyromegaly Chest ï‚· Normal breath sounds ï‚· God air entry Cardiac ï‚· Normal heart sounds ï‚· (-) for murmurs, rubs, and gallops Abdomen ï‚· Soft, non-tender, not distended ï‚· ( + ) Bowel sounds ï‚· (-) for masses, organomegaly, and guarding Genitalia/Rectum ï‚· Genitalia normal ï‚· Circumcised male ï‚· Rectal exam not performed Musculoskeletal/Extremities ï‚· (-) for adenopathy, lesions, rashes, joint swelling, and tenderness ï‚· Good ROM throughout ï‚· (-) for edema, clubbing, and cyanosis ï‚· Peripheral pulses 2 + throughout Neurological ï‚· CNs II – XII intact ï‚· DTRs exaggerated at 3+ throughout ï‚· Active & Oriented to person, place and time ï‚· No focal abnormalities ï‚· Normal strength and tone ï‚· Plantar flexion normal Laboratory Blood Test Results (Fasting) See patient case table 40. 2 CT Scan ï‚· 1.5 inch irregular mass in left temporal lobe ï‚· No herniation of brain tissue noted Electroencephalogram: Within Normal limits from 72 hours since last attack Biopsy of left Temporal Lobe Lesion ï‚· Highly vascular and anaplastic neoplasm with histologic features consistent with poorly differentiated astrocytoma (glioblastoma multiforme) ï‚· Clinical course of this type of brain cancer is usually rapidly progressive with poor prognosis; metastasis is rare; total surgical removal is usually not possible; radiation and chemotherapy may prolong survival Patient Case Questions: 1. Why is there an electrical activity in the brain and what’s its function? 2. Describe how it is used by neurons. 3. What’s the physiology of seizures activity in the brain? 4. What is epilepsy? How is it diagnosed? What are the procedures for doing an EEG test and MRI scan? What type of information does each of these tests provide? 5. What are some possible causes of seizures other than epilepsy? 6. what are the distinct patient complaints that are consistent with a diagnosis of complex partial seizure activity 7. What should you do during a seizure to help this patient? 8. What are complications of frequent seizure activity for this patient? 9. What are the treatment modalities and the recent updates for epilepsy? 10. Discuss pharmacological and non-pharmacological management in this case scenario want answers in detail with explanation and references SCIENCE HEALTH SCIENCE NURSING NUR 123

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