Case of the month:  Young man with first time seizures  in life !
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Case of the month: Young man with first time seizures in life !

Clinical scenario:  A 39 yr old male presented with history of generalised tonic clonic convulsions of 1 hour duration and was brought to Emergency room of our hospital.
There was no history of  viral prodrome , offending drug intake . He had no past history of seizures .After initial brief history from relatives and relevant examination  blood was extracted for labs and   oxygen @ 4 Litres /min was  started .An IV line with Dextrose 10% was  started Patient’s seizures were controlled with 4 mg IV Lorazepam  and later Phenytoin 20mg/kg loading was started in normal saline.  

Examination :  After the seizures were controlled he was  arousable to deep stimulus and  was moving all four limbs .There was no neck stiffness and   plantars were bilaterally upgoing (Postictal state ).There was no neurological deficit. Fundus exam was normal .Systemic examination was normal .

Evaluation: He had hemoglobin levels of  14.9gm/dl ,platelet  count  WBC count were  normal  .   He had normal Liver and  renal functions .CT scan head was done Fig1 it showed diffuse cysts in the brain suggestive of Neurocysticercosis and later the serology came  positive for Neurocysticercosis.  

Fig 1 CT scan head showing cysticercosis. 

Patient was started on Albendazole 800 mg /day in two divided doses for 2 weeks and oral antiepileptic drugs  . He was discharged home with an advice for follow up .

Fig2 This is how parasitic cysts  look in the brain autopsy 

 Neurocysticercosis :  Further reading click the Link 

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