Dr. Hitesh Kumar
Neurology
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Patient's Query
Hello doctor,
My husband fell out of bed after sleeping for 4 hours and was unconscious. He recalls waking up and looking at the clock and seeing that it was 4 am and was confused about why he was awake, and he said the next thing he knew, he was on the floor. When I found him beside the bed, he was flat on his back and completely stiff. I screamed and shook him for several minutes before he became conscious again and was very confused, and then he experienced full body shaking for 2 hours afterward. Was this a nocturnal seizure? He is a male weighing 125 pounds and on allergy medicines including Montelukast and Benadryl. A CT scan, A1C, and EKG was done, and the results came normal.
Hello,
Welcome to icliniq.com.
I would like to know details about the incident:
1) At what time did you find him on the floor?
2) Was he conscious and responding to your commands during full body shaking?
3) Was he continuously shaking for those 2 hours? Or was he shaking intermittently during those 2 hours?
4) Was there any urinary incontinence, tongue bite, or bodily injury also?
5) Does he remember the incident while he fell down on the floor or had a shaking body?
6) Has there been a similar episode in the past ever?
7) This episode happened how many days ago?
8) Has he been started on some antiepileptics already?
Please revert to the above-mentioned information for better understanding and further decision-making. Also, please send the investigations done (computerized tomography head and blood work) till now.
Patient's Query
Hello doctor,
1) I would say approximately 30 seconds to 1 minute after he fell, but I did not look at my watch. I heard the noise of him falling and screamed because I did not know what it was. I yelled for him because when he was not in bed, I thought maybe he had gone to the bathroom, but after yelling and he was not responding, I went to go look for him and found him on the floor. When he finally regained consciousness, he looked at his watch and said it was 4 am. It was very difficult to get him to regain consciousness, I had been shaking him and screaming and he was not moving, and it seemed like it was several seconds from when I got to him before he took a breath after tilting his head back and then his breathing seemed slow.
2) Yes, he was conscious and responding at the time of the full body shaking that he experienced.
3) He was shaking intermittently but would only stop shaking for a few minutes at a time and then start again.
4) No urinary incontinence or tongue bite. After he regained consciousness, I noticed that the large air purifier we keep on the ground was knocked over, so not sure if he had hit it. He had a headache and trouble with looking at screens for a few days after, so we think maybe some mild concussion symptoms.
5) He does not remember falling; the last thing he remembers is lying in bed and looking at his watch. He remembers waking up to me screaming and shaking him, and he remembered the full body shaking afterward.
6) There has not been a similar episode in the past.
7) It has now been ten days now.
8) He has not been started on antiepileptics, but I am concerned he needs to be on one as it seems he could be seriously injured if this were to happen again, and if I were not there, I am not sure if he would have started breathing on his own.
Hello,
Welcome back to icliniq.com.
As per your description, the patient does not remember the incident of falling down on the floor, But he remembers the whole body shaking episodes and was conscious at those shaking times. And the loss of awareness has been there for a duration of maybe 1 to 2 minutes. Usually, a seizure involves all four limbs, and the patient will not be awake and responding to commands. However, the patient can be awake in case of a partial seizure (shaking involving only one or two limbs), so being awake and responding puts a question on the possibility of a seizure for those shaking episodes which your husband experienced. But for the initial episode of loss of consciousness episode, no eyewitness for the whole incident is available, and thus that episode may be a seizure or syncope. Please undertake MRI (magnetic resonance imaging) brain with epilepsy protocol, EEG (electroencephalogram), 2D echocardiography, Holter monitoring, bilateral carotid artery, and vertebral artery doppler test, and T3, T4, TSH (thyroid stimulating hormone) test. If the patient is suspected of having a seizure, MRI Brain is a better tool than CT (computerized tomography) head to look for any lesion in the brain causing seizures. Also, the patient should be evaluated, considering the possibility of syncope. As it has been the first time such an event has occurred, and by the given history, it is not clearly evident to be a seizure. If the evaluation point toward any conclusion or if the event recurs and the clinical description gives some further clue, then we can proceed accordingly. Meanwhile, avoid swimming, driving, and being near a bonfire. Take blood pressure measurements supine at 1 minute and standing at 3 minutes, twice daily, and make a chart. Please review with reports.
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Neurology
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