Jk Case Summary

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Pages: 7
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Patient: JK

Author: Kaley Murday, MS3.

Date seen: 05/15/24.

Chief complaint: Spell concerning seizure.

The History of Present Illness: JK is a 5-year-old female patient with a history of autism and head trauma at 4 months of age now admitted to the Neurology Ward at Children’s Hospital of Pittsburgh (CHP) for a seizure. Patient’s mother reported that patient was playing on the floor, lying down when Mom noticed that patient’s head was repeatedly hitting the ground. Upon walking closer, Mom realized the patient’s whole body was shaking for 1 minute and she was drooling, and her eyes were rolling back in her head. This was followed by a 5-minute period of staring unresponsive. This cycle then repeated; a 1-minute period of full-body shaking, …show more content…
No ataxic movement with heel to shin sliding. No dysdiadochokinesis with rapid alternating hand movements. Romberg signs a negative. Patient was able to toe walk, heel walk, and tandem walk.

Reflexes: Biceps reflex, triceps reflex, and brachioradialis reflex 2/4 on right side. Unable to obtain upper extremity reflexes on left side due to IV guard and pulse oximeter. Patellar reflex: 2/4 on the right and 3/4 on the left. Achilles reflex 2/4 bilaterally. Babinski was negative bilaterally.

Results Review Labs Fishbone Labs (Past 24 hours) AST |-- 30 13.7 / 139 | 108 | 13 / Ca |-- 10.4 ALT |-- 20 INR |-- 1.2 8.2 |--------| 339 ------- |------- |--------| 103 Mg |-- 1.8 TBili |-- 0.6 PTT |-- 29 / 38.8 4.3 | 24.0 | 0.41 Phos |--

Numbers in red represent values outside of the normally accepted ranges, however no values were of concern to the care team.

ECG ECG demonstrates normal sinus rhythm with sinus arrhythmia. ECG is additionally notable for possible left ventricular hypertrophy.

Fast MRI Diagnostic images were unable to be obtained due to excessive motion as per the MRI reading. However, upon discussion with the care team, from the images that were obtained, there were no acute events such as a large mass or …show more content…
Seizure-like episode a. MRI with and without contrast. This should be done to make sure there are no focal lesions that could trigger a seizure. Additionally, given the head trauma this patient endured in infancy, it is important to make sure that the brain’s architecture developed normally. b. Continuous EEG with hyperventilation and strobe testing. The care team wants to see if a seizure can be provoked and if it is provoked, what does the seizure look like on EEG? c. Send patient home with rescue medication. In the case of status epilepticus, or 5 minutes of seizing or 2 or more consecutive seizures without regaining consciousness, the patient’s family will be given VALTOCO or another rescue seizure medication to give the patient. d. In the event of abnormal EEG activity, consult genetics to explore the genetic causes of epilepsy. 2. What is the difference between a'smart' and a'smart'? Increased urinary frequency a. Obtain a urine analysis in order to rule out urinary tract infection, and infectious causes of the seizure. ECG for left ventricle hypertrophy a. Repeat ECG and refer patient to visit a cardiologist on an outpatient basis. 4. What is the difference between a.. Unaddressed ADHD and autism. Refer patient to child development specialist for follow-up on PCP’s ADHD and autism diagnoses. A child development specialist can administer the ADOS-2 or another similar test to confirm an autism
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