1. INTERESTING CASE
PRESENTATION
Dr. Ankit Raiyani
1st year Medicine Resident
LTMGH, Sion

2. Case history
 Mrs. S 27 years female, R/O Diva, married, housewife
 Patient was asymptomatic 6 months back
 Patient p/w/c/o
- tingling and numbness:- episodic
- starting in Left LL toes
- gradually progressing proximally involving whole LL
- spreading upwards involving Lt UL
- lasted for 4 hrs, spontaneously recovered
- F/b heaviness of Lt UL & LL, lasting for whole day
- 4 episodes in last 6 mths, including once in sleep ?
when pt woke in night with same heaviness of limbs

3. Negative history
 No h/o fever
 No h/o Vx, LM
 No h/o trauma, pain in neck
 No h/o loss of conciousness,
convulsions
 Patient not a known case of HTN, DM,
PTB

4. On Examination
 GC- fair
 P- 76/min regular
 BP- 110/70 mm of Hg
 No POLICE
 CVS - heart sounds heard normally
 P/A - soft
 RS - AEBE
 CNS- pt concious oriented
 No focal deficit
 No neck stiffness

5. Investigations
 Hb- 9.3
 WBC- 6800
 DLC- 72/26/2/0
 PLT- 214000
 LFT/RFT- WNL
 RBS- 89
 Na/K- 138/3.4
 Ca- 8.2
 Mg- 2.0
 Free T3/T4/TSH- 3.09/0.97/2.37

6. Inv. contd
 MRI brain with epilepsy protocol with
screening of cervical spine
 Normal study
 EEG-
 Baseline beta activity in range 10-13 cps
 E/o occassional bursts of sharp wave discharges
 No e/o slow waves
 Imp- EEG s/o seizure activity

7. Our impression
Somatosensory seizure disorder

8. Treatment
 Tab eptoin (100mg) tds
 Tab Cal Lactate (500mg) tds
 Tab Folic Acid (5mg) tds

9. Somatosensory seizures
 Subtype of simple partial seizures
 Focus of seizures- C/L postrolandic
convolution
 Sensory disorder-
 Numbness, tingling, “pins & needles” feeling
 Occasionally sensation of formication,
electricity, movement of body parts
 Rarely pain & thermal sensations

10. Somatosensory seizures
 Etiology- in ~70% cases etiology can be
ascertained
 ICSOL, AV malformations, intra cranial
hemorrhages responsible for majority
cases
 In 30% etiology not known

11. Somatosensory seizures
 Onset of seizures-in majority cases lips,
fingers, or toes
 Spread to other parts follows a pattern
determined by sensory arrangements in
postrolandic convolution of the parietal
lobe

12. Investigations
 Imaging studies
 CT/MRI scan
 SPECT
 PET scan
 Functional MRI scan
 Electroencephalogram

13. Treatment
 Antiepilaptics
 Neurosurgery

14. THANK YOU!!