Seizure disorder- Hypoxic Ischemic Encephalopathy and Colpocephaly Chief Complaints A 18 yr old female attended Mopd with 1 episode of Generalized Convulsion 1 days back. There was associated tongue bite,frothing of mouth , post ictal confusion and Urine incontinence. No associated fever,headache, nausea or vomiting, Dizziness,slurring of speech,Neck rigidity,limb weakness, chest pain or palpitation,Diaphoresis. She had similar episodes of convulsion in past since childhood but stopped medicine after 2 yrs . No reports available. No H/O HTN/DM/Thyroid disorder or substance abuse. On multiple questioning pt father answered regarding her birth history. She was born at home by local dai and it was prolong labour. Normal Menstrual cycle. General and Systemic Examination normal except pt has low height for her age. No Mental retardation with Normal MMSE score. Routine Ix along CT Brain was advised. Next day pt attended Mopd with reports showing- Raised ALP ( due to growing age ) Rest blood reports normal. CT Brain- Asymmetrical enlargement of occipital horn of left lateral ventricle suggestive of colpocephaly. Subtle reduced density of the cerebrum relative to cerebellum may suggest mild/early diffuse edema. Next MRI Brain and EEG was advised . Tests were done and reports show - MRI Brain- FEATURES OF LEFT PERITRIAGONAL WHITE MATTER VOLUME LOSS WITH COLPOCEPHALY - PATTERN OF THE LESION IS SUGGESTIVE OF OLD MILD H.I.E. EEG - AN ABNORMAL EEG SHOWING GENERALIZED SLOW AND SHARP WAVE ACTIVITY. Pt started on Anti convulsant and put under follow up.

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Case is workedout in detail with good information Colpocephalic horn lt occipital ventricle is concerned and cause of seizures Supported by generalised spikes activity in EEG Brain oedema Yes it is a c/o grand mal convulsions Need to put on anticonvulsants for at least 5years Diuretcs till brain oedema reduces Out of your detail workout I am failled to see electrolyte to r/o hyponatremia

Very well managed case This patient may need life time anticonvulsant therapy because of epileptogenic focus in brain

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Convulsions Clopocephaly Asymmetrical enlarge 3 rd ventricle Resulting in blockage of csf Resulting in hydrocephalus Mri eeg Opinion of neurologist

To continue Anticonvulsant Deepakote ( Valproic AcId) If no seizure for 4 years An EEG to be done before taking decision to stop the drug Look for side effects Liver function tests every 3 months Dermatological side effects Gastric side effects

Eptoin.Ioomg.tid daily Lobochek.5mg....bid.daily. Riisperidone..3mg...o.d.at night. Avoid Spicy and alcoholic foods. Juicy and liquid foods, vegatbls and greens and flowers. Physiotherapy , insper and exhale excise...bid ..mrng and bed time. Avoid excess water, tea and Coffee... Remain Stress free and noisy and,hari community....

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