GirevikMedic
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https://en.wikipedia.org/wiki/Frontal_lobe_epilepsy
Last run of the day yesterday. Seemed an obvious psych episode - nope. Seizure. Fully legit, just so completely atypical.
Get on scene, fire meets us out front informing us we'll need a spit mask and 4 points. Inside, step-dad and fire have the kid (OK he was 20 but I'm a spry 35 so...) pinned on the couch, kneeling prone with one hand pinned behind his back like LEOs before slapping on the bracelets. Patient is conscious, verbally belligerent screaming nonsense but lucid enough to know what's going on, physically restless and combative (nonviolent just uncontrollable/unmanageable without restraints).
Family keeps saying this is a seizure and this is what happens and that someone has to be around him almost constantly because of the frequency of episodes and/or the extent of the behavior. Family has medical records for us to check but it's a folder about a half-inch thick, somewhat out of order and at least two years old thus difficult to make sense in the moment. Also, medications didn't match up. Paperwork listed Depakote. Patient currently on zonisamide (listed nowhere in the paperwork given). Allergic to Lamictal.
At this point the consensus between us and FD was that it was more clearly a case of an obvious psych outburst with a behavioral risk/history and the family believing it to be something else for whatever reason. Well... flipping through the folder of old papers and whadyaknow? By chance thumbed through some pages and just happened to land on probably the one page that spelled it out. A post visit summary/diagnosis from previous tests/imaging and exams buried about halfway down. The verdict... a form of frontal lobe epilepsy producing the atypical presentation. Some quick Google-Fu and... yup... perfect fit. Also found out that he had an arachnoid cyst which was never mentioned on scene.
One thing's for sure. The medical field always has something new for you to chew on no matter how long you've been out there. Pretty interesting case IMO. Who else has had cases where it looked like a duck, walked like a duck, quacked like a duck... but was a horse?
- Motor symptoms: Facial grimacing and complex automatisms like kicking and pelvic thrusting
- Vocal symptoms: Laughing, yelling, or speech arrest
- Motor symptoms of seizures in this area are accompanied by emotional feelings and viscerosensory symptoms. Motor and vocal agitation are similar to that of the SMA with short repetitive thrashing, pedaling, thrusting, laughing, screaming and/or crying.
- This is some of what can cause the misdiagnosis of a psychological disorder
Last run of the day yesterday. Seemed an obvious psych episode - nope. Seizure. Fully legit, just so completely atypical.
Get on scene, fire meets us out front informing us we'll need a spit mask and 4 points. Inside, step-dad and fire have the kid (OK he was 20 but I'm a spry 35 so...) pinned on the couch, kneeling prone with one hand pinned behind his back like LEOs before slapping on the bracelets. Patient is conscious, verbally belligerent screaming nonsense but lucid enough to know what's going on, physically restless and combative (nonviolent just uncontrollable/unmanageable without restraints).
Family keeps saying this is a seizure and this is what happens and that someone has to be around him almost constantly because of the frequency of episodes and/or the extent of the behavior. Family has medical records for us to check but it's a folder about a half-inch thick, somewhat out of order and at least two years old thus difficult to make sense in the moment. Also, medications didn't match up. Paperwork listed Depakote. Patient currently on zonisamide (listed nowhere in the paperwork given). Allergic to Lamictal.
At this point the consensus between us and FD was that it was more clearly a case of an obvious psych outburst with a behavioral risk/history and the family believing it to be something else for whatever reason. Well... flipping through the folder of old papers and whadyaknow? By chance thumbed through some pages and just happened to land on probably the one page that spelled it out. A post visit summary/diagnosis from previous tests/imaging and exams buried about halfway down. The verdict... a form of frontal lobe epilepsy producing the atypical presentation. Some quick Google-Fu and... yup... perfect fit. Also found out that he had an arachnoid cyst which was never mentioned on scene.
One thing's for sure. The medical field always has something new for you to chew on no matter how long you've been out there. Pretty interesting case IMO. Who else has had cases where it looked like a duck, walked like a duck, quacked like a duck... but was a horse?