Age: 49.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Blood chloride decreased, Blood creatinine normal, Blood ethanol normal, Blood glucose normal, Blood lactic acid
Clinical narrative: History obtained from: patient History limited by: mild confusion   Chief Complaint: Seizure   HISTORY OF PRESENT ILLNESS   a 49 y.o. female who presents to the Emergency Department complaining of seizure onset prior to arrival.    Per Nurse, the patient had a headache and vomiting all day. Patient was given Zofran in the hallway for nausea. Patient was post-ictal upon EMS arrival. Patient has never had a seizure before.    Per Husband, the patient has had a headache and has been vomiting all day. Patient states that her frontal headache got worse throughout the day. Patient was found on the bed, shaking, stiff, and eyes had rolled back for about 5 minutes. Husband states that she returned back to baseline in 5 minutes. Patient states that she bit her lip. Patient mentions that she never gets migraines. Patient reports photophobia, sound sensitivity, and feeling of being hot and cold throughout the day. Husband states that she has her Covid-19 vaccinations. Husband also mentions that she has been using Pepto Bismol throughout the day without relief. Patient denies vision loss, difficulty swallowing, one-sided weakness/numbness, neck stiffness/pain, nasal congestion, abdominal pain, dysuria, hematuria, hematochezia, and any sick contacts.    Caveat: Full history of present illness is unobtainable from patient secondary to mild confusion  Chief Complaint:  Seizure, confusion 49 y.o. female with a history of tobacco abuse who presents with new onset seizures.  History as per EMR and as per patient's mother with home I spoke on the telephone.  Patient was apparently complaining of a headache all throughout the day, had multiple episodes of nonbloody and nonbilious emesis at home.  She then had 1 episode of seizure at home which lasted for a few minutes, she bit her lip during this episode.  She returned to baseline mental status in about 5 minutes.  Patient's mother tells me that she does not use any illicit drugs, but smokes marijuana occasionally.  She drinks alcohol socially, has not had any history of seizures in the past.  Her mother does not recollect any recent changes to her lifestyle in the past few days except that she received her Johnson & Johnson COVID-19 vaccine about 2 weeks ago.     Patient came to the ED, while in the waiting room, she had another episode of witnessed seizure that lasted a few seconds. She was then brought back into her room in the ED and had yet another episode of seizure, was given Ativan and 1000 mg IV Keppra.  Admitted for further management.   COVID-19 vaccination status:  Vaccinated (J and J), yet to receive booster. COVID-19 test:  Negative today.     Chief Complaint:  New onset seizures   History of Present Illness:    History was obtained from a review of the electronic record and discussion with the patient . 49 y.o. female who presented to the ER on 12/20/2021 after having new onset seizure.  The patient has been vomiting with the headache.  Her boyfriend witnessed her having seizure which lasted for a few seconds.  After presenting to the hospital, patient had a CT brain which was negative for any acute abnormality.  The patient had another witnessed seizure for which she was started on Keppra.  She was admitted to the hospital, neurology evaluated the patient at bedside.  She was feeling better.  She denied any acute symptoms.  The patient does not recall much of the events from yesterday.  She denies any previous history of seizures or any family history of seizures.  She did have a tongue bite from the seizure.  Her urinalysis was positive for fentanyl and cannabinoids.  She does admit to drinking alcohol twice weekly.  Assessment and Plan:   1)  new onset seizure, etiology unclear, possibly provoked from underlying polysubstance abuse Recommendations:  -continue Keppra 500 mg twice daily -MRI brain without contrast pending to evaluate for any structural abnormality -EEG currently pending Per DMV law: Patient is advised to not drive motorized or nonmotorized vehicle for 6 months since last seizure or loss of consciousness event. Do not engage in heavy machinery work, taking bath or swimming unsupervised to ensure your safety.  -If patient has a seizure which lasts more the 5 minutes, three consecutive seizures without recovery between seizures, or has injury during seizure, please take patient to the emergency department; if the patient has any respiratory distress due to seizure, please place patient on his/her side and call 911 -patient can follow up in Neurology clinic for next available appointment, please call Neurology for any questions