This is a 16-year-old male who presents to the clinic having had an episode
of loss of consciousness approximately one week ago. The event occurred
shortly after awakening and while brushing his teeth. His mother heard
him groan loudly and found him on the floor in an unconscious state. Per
the report of his mother, there was rhythmic jerking of his arms and legs
lasting no longer than a minute in duration. He remained in an unarousable
state for approximately five more minutes with slowed, heavy breathing.
Paramedics were summoned to the home and found the boy in a confused and
combative state and transported him to a local emergency room for evaluation.
He recalls awakening in the emergency room and receiving a blood test
and a “special” x-ray of his brain. He was then discharged
from the emergency room and told to follow up with a neurologist. A clinic
appointment was made upon referral from the emergency room. Unfortunately,
the clinic has not yet received a copy of the emergency room evaluation.
This patient denies previous episodes of loss of consciousness, vertigo
or lightheadedness. He denies history of headaches, episodic weakness
or sensory loss. He has had several episodes of isolated and brief whole-body
“jerks” which have occurred while eating his breakfast.
Review of symptoms is otherwise unremarkable.
Father with elevated cholesterol. Mother in good health. No history of
neurologic disease in first degree relatives.
He is a sophomore in high school receiving good grades. Has one younger
sister in good health. Denies alcohol, tobacco or recreational drug use.
BP 105/60 HR 70
General: Appears well dressed and nourished, no apparent
Mental Status: Comprehension and fluency intact. Alert
HEENT: Head is normocephalic and atraumatic. Neck is
supple with full range of motion and no adenopathy. Funduscopic examination
is normal. Pupils are equally reactive to light and accommodation. Visual
fields are full to confrontational testing. extraocular movements are
full. Facial sensation and strength is symmetrically normal. Hearing is
symmetric. Palatal elevation is symmetric with normal gag reflex. There
is symmetric strength with head turn and shoulder shrug. Tongue protrudes
on the midline.
Motor (Power/Tone/Bulk): Normal symmetric tone and bulk
of muscles. Strength is 5/5 in the upper and lower extremities.
Sensory: Symmetrically intact to vibration and pin in
Reflexes: 2+/4 symmetric in the biceps, triceps, brachioradialis,
patellar and Achilles tendons. Toes are downgoing (flexor) to plantar
Coordination: Normal finger-to-nose testing and rapid
Abnormal Movements: None