Referred case from HRPZ Kota Bharu

Ruslina bt mohd isa 
011212110564 

20years old lady 
previously NKMI / NKDA 
Denied high risk behaviour 

Referred from Hosp Tengku Anis for fitting tro cause 

p/w fitting episode at 8.00pm yesterday 
1st episode 
generalized tonic clonic of upper limb 
uprolling of eyeballs 
drooling of saliva 
clenching of teeth 

Had history of fever 1/52 ago , went to GP , given Tab PCM , claimed fever resolved. 

associated with
+ persistent headache for 2/52 , claimed worsening yesterday 
+ vomiting - 2 episode yesterday 
non projectile
+ lethargy  

otherwise , 
no limb weakness 
no blurring of vision 
no syncopal attack 
no altered behavior 
no palpitation 
no sob 
no sick contact 
no contact with covid 19 pt 
no recent travelling to redzone area

o/e alert , GCS 14/15 , pupils reactive bilaterally 3mm , not tachypneic , good PV , CRT < 2ses , warm peripheries , no facial asymmetrical 
BP  109/68
PR83
RR 21
T 37.7 
PS 5
SPO2 95% 
GM 6.7 

lung clear , equal air entry 
cvs  S1S2 
p/a  soft , non tender ,not distended 

cns examination : 
Right UL and LL 
tone : normal 
power : 5/5 
reflex : normal 
clonus :  absence 
Babinski : equivocal

Left UL and LL : 
Tone : normal 
power : 5/5 
reflex : normal 
clonus : absence 
Babinski : downgoing 

IX 
TWC 8.6 

CT brain : left temporal venous infarction with haemorrhagic transformation due to left cerebral dural venous thrombosis

imp :
1. Space occupying lesion of left parietal occipital 
DDx:
1. TRO brain abscess
2. TRO malignancy