| Case 8 March 8, 11:00 a.m. | ||
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HPI
A 26-year-old woman presents with a six-month history of "spells". The spells are all the same and start with a feeling in the abdomen that is difficult for her to describe. This feeling rises up towards the head. The patient believes that she will then lose awareness. On one occasion she reports missing a 4-5 minute segment of her favorite television program. A friend who observed one of these spells reported that she did not respond to her for about 2 minutes, appeared to be staring and may have had a dry mouth since she was continually moving her lips and tongue during this time. The patient has had a total of 4 such spells in the past six months. The spells appear to come on when she is under stress and has not been sleeping well. She also states that at times she will just get the abdominal sensation for about 10 seconds and remains fully aware of her surroundings. PMH Is unremarkable except that when she was about 2 years old she was hospitalized for a couple of days with a high fever and a possible seizure. She fell of her bike when she was 10 years old hitting her head, she had a scalp laceration but was not hospitalized. Her medications include birth control pills and occasional ibuprofen. FH PE
When the patient was seen 3 weeks later, a CT scan of the head and a routine electroencephalogram were both unremarkable. Results of routine blood studies were unremarkable. An electrocardiogram was normal. The patient has had two more spells very similar to the earlier ones. She was involved in a car accident. She thinks that she had one of her spells while driving and was told by the police that she went through a red light.
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