# Unknown cause seizures



## HMartinho (Jun 3, 2012)

At ILS my shift, we were called to a rural area. A man of 70 years, unconsciousness and have periods of seizures. When we arrive, he was in recovery position, and his daughter was with him, very agitated.

Physical assessment and vital signs:

- pupils  are dilated and have a small response to light
- GCS: 11
- RR: 15
- HR: 68
- BP: 140/95
- Temp: 36 ºC / 96,8 ºF
- SpO2: 95 on room air
- 3 and 12 lead ECG shows normal sinus rythm

He have no signs of CVA or TIA
My nurse-partner inserted an naso tube, O2, and IV line, while I got his medical history.

He has hypertension and takes everyday captopril and indapamide.
In the last months, he has felt severe headaches, but his family physician depreciated his symptoms, prescribing Codeine + acetaminophen. He ate 2 hours ago.

When we load him to the ambulance, suddenly he has another tonic-clonic seizure, and the nurse gave 5 mg of diazepam, slow IV push. We transport him to nearest central ER, with neuro service.

In the E.R., he did some diagnostic tests:

- Blood tests
- MRI
- CT scan

My nurse-partner could have access to CT scan, which is attached.

What are your guesses?

Play, and have fun !


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## Dwindlin (Jun 3, 2012)

Picture is small, and when I increase it I lose detail, so it's tough to make out. I convinced myself a few of the frames show ring enhancement.  Best guess looking at those pictures is either an abscess (though unlikely with no fever or other indications of infective process) or tumor (with the possible ring enhancement likely a GBM).  Could be a chronic bleed I suppose, but that location I would not think blood would accumulate slowly enough to become chronic looking on CT without causing more than headaches.


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## ParamedicChick (Jul 11, 2012)

With a hx of headaches I'd say a tumor or abscess is def a possibility as well.  I don't have much experience looking at images but the frontal lobe looks abnormal, something resembling a tumor that is putting pressure, which is common to cause seizures.  No previous trauma?


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## brianamato (Jul 11, 2012)

ParamedicChick said:


> With a hx of headaches I'd say a tumor or abscess is def a possibility as well.  I don't have much experience looking at images but the frontal lobe looks abnormal, something resembling a tumor that is putting pressure, which is common to cause seizures.  No previous trauma?




ffsZ


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## bigbaldguy (Jul 11, 2012)

Possible Mild hydrocephalus and a Meningioma.


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## bigbaldguy (Jul 11, 2012)

On second thought it doesn't look like hydrocephalus but I still think that could be a meningioma.


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## EMT91 (Jul 11, 2012)

How long have the seizures been occurring? Was the day of the call the first instance of seizing?  Or has it been going on for some time?


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## EMT91 (Jul 11, 2012)

Dwindlin said:


> Picture is small, and when I increase it I lose detail, so it's tough to make out. I convinced myself a few of the frames show ring enhancement.  Best guess looking at those pictures is either an abscess *(though unlikely with no fever or other indications of infective process)* or tumor (with the possible ring enhancement likely a GBM).  Could be a chronic bleed I suppose, but that location I would not think blood would accumulate slowly enough to become chronic looking on CT without causing more than headaches.



However, and mind you, I am only a Intermediate student, so I mean not suggest that I know more than you, because I know I know MUCH less then you. However, could the acetaminophen be masking his fever?


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## Dwindlin (Jul 11, 2012)

EMT91 said:


> However, and mind you, I am only a Intermediate student, so I mean not suggest that I know more than you, because I know I know MUCH less then you. However, could the acetaminophen be masking his fever?



Absolutely.  If that is an abscess it is quite large.  There should have been some sign of infection that was reported in the history, plus headaches for months make me think more tumor/chronic bleed.


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## EMT91 (Jul 11, 2012)

Dwindlin said:


> Absolutely.  If that is an abscess it is quite large.  There should have been some sign of infection that was reported in the history, plus headaches for months make me think more tumor/chronic bleed.



Ok. So my thinking was not totally wrong lol


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## Dwindlin (Jul 11, 2012)

EMT91 said:


> Ok. So my thinking was not totally wrong lol



Not wrong at all with regard to the Tylenol, it can definitely mask a fever, I just believe there are other historical items that point away from infection.  I could be just as wrong as anyone though.


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## HMartinho (Jul 11, 2012)

Sorry about the bad quality, but my partner  scanned the CT scan with the hospital's computer. It is the best that he could.

His daughter is not sure how long the seizure lasted. The seizure in the ambulance stopped shortly after the diazepam. Well, I can say that it's not a tumor.


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## bigbaldguy (Jul 11, 2012)

HMartinho said:


> Well, I can say that it's not a tumor.



Damn  Well at least I got to use a big word.


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## Dwindlin (Jul 11, 2012)

HMartinho said:


> Sorry about the bad quality, but my partner  scanned the CT scan with the hospital's computer. It is the best that he could.
> 
> His daughter is not sure how long the seizure lasted. The seizure in the ambulance stopped shortly after the diazepam. Well, I can say that it's not a tumor.



What did it turn out to be?


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## HMartinho (Aug 24, 2012)

Dwindlin said:


> What did it turn out to be?



Calcified and noncalcified cysticercus lesions compatible with neurocysticercosis. 

he was admitted in intensive care, while waiting for neuro surgery. The neurosurgeon said he had not seen an so severe case of neurocysticercosis in his entire career.


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## EpiEMS (Aug 24, 2012)

HMartinho said:


> Calcified and noncalcified cysticercus lesions compatible with neurocysticercosis.
> 
> he was admitted in intensive care, while waiting for neuro surgery. The neurosurgeon said he had not seen an so severe case of neurocysticercosis in his entire career.



Wow. Glad I don't eat pork!


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## HMartinho (Aug 24, 2012)

EpiEMS said:


> Wow. Glad I don't eat pork!



If the pork is well frozen and cooked, there is no risk (or minimum risk). But you're right, there are much healthier meat/protein sources than pork.


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## epipusher (Aug 25, 2012)

Any reason for a blood sugar not being a part of the initial vitals?


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## HMartinho (Aug 25, 2012)

epipusher said:


> Any reason for a blood sugar not being a part of the initial vitals?



Yes, the glucometer was broken. We just had a new one,  1 week later.


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