15 y.o. Boy
playing touch football when symptoms developed
Became unreasonably angry at his friend
Fell to the ground with sudden onset of unconsciousness
His body stiffened with arms and legs extended
He did not breathe for about 10 seconds
He then began violent,rhythmic, muscular contractions accompanied by strenuous hyperventilation that lasted 2 or 3 minutes
Incontinent of urine
He then lay limp, breathing rapidly, and woke up confused
Presented 1 hour later in the ER
Q1: What is your differential diagnosis based on the information you now have?
Seizure possibly related to: Vascular pathology(TIA or stroke)
Tumor or other neoplastic issue
Drug/alcohol use and/or withdrawal Endocrineissue(hypoglycemia,hyponatremia,hypernatremia,hypocalcemia,hypercalcemia)
Rationale: The patient presents to the ER with only subjective information, after determining that a true seizure occurred, identifying the cause of the seizure is urgent. The subjective information provided can help with differential diagnosis and determining seizure type. The description of the incident and post-event confusion are strong indicators that a seizure did indeed take place.
Q2: What other questions would you like to ask now?
Do you remember what happened?
Do you remember what you were doing immediately prior to the event?
Any lapses in memory, episodes of confusion, unexplained injuries?
Have you had any recent accidents? Any injuries involving your head?
Have you had any headaches? If so, how recent? Describe nature of headache.
Any history of using or abusing drugs or alcohol?
Have you had any infections including sinus, ear, or staph infection in the last six months? If so, when? Describe course of infection.
Have you had any recent fevers? If so, do you know what...