13 year old female with Generalized tonic clinic seizures

A 13 year old was brought to the casualty with chief complaints of generalized tonic clinic seizures since 6 30 in the morning
Patient had episodes of GTCS ?  for 10 minutes associated with up rolling eyeballs, frothing present, tongue bite present, associated with fall (sustained head injury in frontal area) 
5 to 6 episodes of GTCS with no regain of consciousness in between for 20 to 30 minutes 
Each episode lasted for 2 to 3 minutes, not associated with involuntary micturition
Patient was taken to a local hospital and was given midazolam and is brought for further management
Associated with headache which is diffuse bilaterally,1 episode of vomiting present, no bilious, watery, ? projectile

Not a k/c/o HTN,DM,Asthma
History of Anti Tubercular therapy taken for 6 months 1 year back

General physical examination
Patient is concious,coherent, oriented to time place and person 
No pallor , icterus cyanosis clubbing and lymphadenopathy

Vitals on admission
Temperature 98 F
PR 125 bpm
RR 24cpm
BP 180/120mmhg 
Grbs 118mg/dl

R/S 
Bilateral air entry present
P/A
Distended
CNS 
Gcs 15/15
Pupil ls reactive (sluggish)
Tone 
            R.                         L 
    UL.   Decreased       Decreased
    LL.    Decreased.      Decreased

Reflexes 
               B.       T.       S.       K.       A.     P
       R.     +         +.      +.       +.       +.      F
       L.      +.        +.      +.        +.      +.      F
Neck rigidity is not present






Diagnosis
Generalized tonic clinic seizures secondary to ? CNS vasculitis ?lupus vasculitis 
?CSVT
? Acute ischemic stroke 
? PRES 
? HTN encephalopathy

Investigations
Hb 8.1
TC 30000
N 72
L 34
Pcv 25.5
RBC 3.09
Plt 2.8

Rbs 83 mg/dl
Blood urea 67mg/dl
S creat 0.7
Na 142
K 3.6
Cl 113
Calcium ionised 1.08
Tb 0.33
Db 0.16
Ast 16
Alt 06
Alkaline phosphatase 185
Total proteins 3.6
Albumin 1.47
A/G ratio 0.66
Uric acid 8.1

pH 7.363
Pco2 25.1
Po2 111
Hco3 13.9
 
Serum magnesium 2.0
Spot urine protein creat ratio 46.5


Treatment
Inj midazolam 2cc IV stat if seizures activity continues
Inj zofer iv sos
Tab wysolone 20mg po/od
Tab HCQ 100mg po/od
Tab lasix 20mg po/bd
Tab met-xl 25mg po/od
Tab telma 40mg po/od
Ryles tube 4th hourly milk + 2 scoops protein powder
4th hourly 100ml water
Inj monocef 500mg iv/bd

Neurosurgery opinion was taken and advised MR angiography 

Ophthalmology opinion was taken i/v/o raised ict changes in fundus examination 

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