Case Summary 1

A 40-year-old woman was admitted to the hospital after her 34-week prenatal office exam revealed 3+ proteinuria, 2+ edema of both lower legs, and an elevated blood pressure of 170/110. The patient had no known history of hypertension in the past. In the office, the patient complained of headache and blurred vision. As she was being wheeled to the obstetrical unit, the patient suffered a generalized tonic-clonic convulsion. The patient was treated for her eclampsia and discharged home to strict bedrest and close follow-up care.
 

Case Summary 2

A 10-year-old boy with a known history of frequent epileptic absence episodes was seen in the emergency department after sustaining contusions to his reight knee and shin in a fall from his bike. He was wearing his helmet. His mom witnessed the accident and thought that he may have had an attack as he was riding. Exam revealed intact mentation in the emergency department, and he stated that he "thought" he remembered losing his balance on a sandy patch in his driveway. His head and neurologic exams were entirely normal without any postictal signs, and x-ray of his right leg did not reveal any fractures. His contusions were cleaned up and he was discharged home in good condition. I am uncertain if this child experienced a seizure with his fall, therefore I advised his mom to follow up with their pediatric neurologist.
 

Case Summary 3

A 37-year-old man was admitted to the hospital following a witnessed grand mal seizure at home. A second seizure occurred en route to the hospital in the ambulance. Past medical history revealed no prior seizure disorder in this patient. Neurologic work-up  was entirely negative, including a negative CT and EEG. A lumbar puncture was negative, as was sepsis work-up. Interestingly, the patient had recently begun taking Prilosec for GERD. After consulting with his internist, consensus was that the seizures were secondary to Prilosec therapy and this medication was stopped. The patient was placed on Dilantin and further seizures did not occur during his hospitalization. He was discharged home in satisfactory condition 72 hours after admission. He will take Propulcid for his reflux disease and Dilantin 400 mg daily for his seizures. He has been instructed to return to the office in 5 days for a Dilantin blood level. He knows that he cannot drive for at least the next three months. This gentleman was quite distressed with this new diagnosis; however, I explained to him that, over the next several weeks, we would be working to eliminate all other causes for his seizures, and that his prognosis was extremely positive.
  

Case Summary 4

A 22-year-old man was admitted following repeated temporal lobe seizures. History revealed that the patient had had 17 seizures within the 24 hours prior to admission. He has had seizures since the age of 14, previously well-controlled with no break-through episodes on Phenobarbital. Blood levels of Phenobarbital indicated an acceptable therapeutic level of 30; however, while in the hospital, the patient continued so seize at least once per hour. Because of the intractability of his epilepsy, it was recommended that the patient be transferred to another facility where he could obtain neurology services. He and his family concurred and he was transferred emergently to the neurology unit of the Regional Health Center.