| { | |
| "Non-epileptic Seizure$Intermedia_3": { | |
| "EEG showed no signs of epilepsy$Cause_1": { | |
| "There are no frank epileptiform discharges or electrographic seizures$Input6": {} | |
| }, | |
| "normal video-EEG rule out epilepsy$Cause_1": { | |
| "a normal video-EEG monitoring session$Input6": {} | |
| }, | |
| "Suspected Epilepsy$Intermedia_2": { | |
| "The patient's long-standing hearing problems and multiple ear surgeries may have led to abnormal body and nervous system responses to pressure, which could be associated with non-epileptic seizures.$Cause_1": { | |
| "bilateral hearingloss and multiple ear surgeries,$Input2": {} | |
| }, | |
| "Vertigo and orthostatic hypotension may cause a temporary lack of blood flow to the brain, triggering a non-epileptic seizure$Cause_1": { | |
| "Immediately after waking from that procedure she had severe vertigo, \"triple\" vision and orthostatic hypotension.$Input2": {} | |
| }, | |
| "Sudden loss of consciousness may be a seizure$Cause_1": { | |
| "she suddenly lost consciousness$Input2": {} | |
| }, | |
| "Whole body shaking may be an epileptic seizure$Cause_1": { | |
| "witnessed of whole body shaking$Input2": {} | |
| }, | |
| "Sensory abnormalities, such as strange tastes or flavors, may be related to abnormal activity in the nervous system.$Cause_1": { | |
| "She recalls a metallic taste and a funny smell$Input2": {} | |
| }, | |
| "These symptoms are common in epileptic seizures$Cause_1": { | |
| "She also bit her tongue and had urinary incontinence$Input2": {} | |
| }, | |
| "The use of sedatives such as diazepam may result in increased sensitivity of the nervous system, triggering or worsening symptoms of non-epileptic seizures.$Cause_1": { | |
| "She has been trying to take less diazepam for the vertigo$Input2": {} | |
| }, | |
| "Neurological problems, such as long-standing headaches, weakness on the side of the body, and new numbness in the hands, may increase the risk of non-epileptic seizures.$Cause_1": { | |
| "Has a chronic bandlike headache. She has chronic left sided weakness since cervical fusion.$Input2": {} | |
| }, | |
| "These are common triggers of non-epileptic seizures$Cause_1": { | |
| "Bilateral hearing loss and surgeries$Input3": {} | |
| }, | |
| "Back surgery and chronic low back pain may lead to chronic pain, which is a known cause of non-epileptic seizures.$Cause_1": { | |
| "Lumbar discectomy and fusion$Input3": {} | |
| } | |
| } | |
| }, | |
| "input1": "Seizure\n", | |
| "input2": "This is a 31 year old woman with a history of bilateral hearingloss and multiple ear surgeries, and subsequent severe vertigo and orthostatic hypotension since the most recent surgery, who presents with 2 events concerning for seizures in the past 24 hours.\n\nThe patient reports bilateral hearing loss since her pregnancy. She thinks this was a result of her pregnancy and a virus. Since that time she has had multiple surgeries to try to improve her hearing including reconstruction of the eustasian tube. Most recently she had tympanoplasty of the right ear. Immediately after waking from that procedure she had severe vertigo, \"triple\" vision and orthostatic hypotension. The vertigo is constant and worse with activity and light. The triple vision is monocular and constant. The orthostatic hypotension is so severe that she passes out with little warning at least daily. She was in rehab for a month due to these symptoms and continues to get rehab. She walks with a walker for only a few minutes at a time.\n\nLast evening around 6pm she was sitting on her bed with her husband and child when she suddenly lost consciousness. She recalls a metallic taste and a funny smell immediately prior to this. He husband witnessed of whole body shaking. She also bit her tongue and had urinary incontinence. Upon regaining consciousness she felt extremely tired all evening and sore with a new headache, but no confusion. This morning around 8am as she was getting her child ready for daycare she had another event with the same prodrome while standing (had been standing for a few minutes). This lasted 5s. She also immediately regained consciousness.\n\nShe has been trying to take less diazepam for the vertigo and only took it once in the morning yesterday, though she has skipped a day in the past. No recent illnesses. Has a chronic bandlike headache. She has chronic left sided weakness since cervical fusion. Now new right hand numbness. + weight loss due to poor appetite.\n \nOn neuro ROS, the pt denies loss of vision, blurred vision, diplopia, dysarthria, dysphagia. Denies difficulties producing or comprehending speech.\n", | |
| "input3": "+Bilateral hearing loss and surgeries\n+Lumbar discectomy and fusion\n", | |
| "input4": "No seizure, stroke. Aunt with multiple strokes.\n", | |
| "input5": "Vitals: 98.44 84 128/91 18 99% \nGeneral: Awake, cooperative, NAD. \nHEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in oropharynx. Tube in left ear, artificial tympanic membrane on the right. \nNeck: Supple \nPulmonary: Lungs CTA bilaterally without R/R/W \nCardiac: RRR, nl. S1S2\nExtremities: No C/C/E bilaterally\n \nNeurologic: \n-Mental Status: Alert, oriented x 3. Able to relate history without difficulty. Grossly attentive to exam. Language is fluent with intact repetition and comprehension. Normal prosody. There were no paraphasic errors. Pt. was able to name both high and low frequency objects. Speech was not dysarthric. Able to follow both midline and appendicular commands. There was no evidence of neglect. \n \n-Cranial Nerves: \nII: PERRL 3 to 2mm and brisk. VFF to confrontation. Funduscopic exam revealed no papilledema, exudates, or hemorrhages. \nIII, IV, VI: EOMI without nystagmus. Slow and irregular saccades-appears volitional. \nV: Facial sensation intact to light touch. \nVII: No facial droop, facial musculature symmetric. \nVIII: Hearing intact to voice. \nIX, X: Palate elevates symmetrically. \nXI: strength in trapezii and SCM bilaterally. \nXII: Tongue protrudes in midline with normal strength\n", | |
| "input6": "___\nEEG\nIMPRESSION: This is a minimally abnormal video-EEG monitoring session. A few isolated sleep-related sharp transients noted in the left temporal region are of questionable clinical significance. There are no frank epileptiform discharges or electrographic seizures. None of the patient's typical events are recorded. \n\n___\nEEG\nIMPRESSION: This is a normal video-EEG monitoring session. The patient had one of her typical episodes which involved whole-body jerking but with immediate ability to follow commands afterwards. No electrographic seizures or epileptiform discharges are recorded. \n\n___\nMR ___\nIMPRESSION: \nNo significant focal lesions. Slightly small left hippocampus on some images; no signal/architectural changes. Fluid in mastoids, right more than left. \n\n___ 05:48AM BLOOD WBC-5.4 RBC-4.51 Hgb-12.5 Hct-38.7 MCV-86 MCH-27.7 MCHC-32.3 RDW-12.7 Plt ___\n___ 05:48AM BLOOD Glucose-83 UreaN-15 Creat-0.7 Na-137 K-3.7 Cl-107 HCO3-24 AnGap-10\n___ 05:48AM BLOOD Calcium-8.3* Phos-3.8 Mg-1.8\n___ 03:00PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG\n" | |
| } |