Seizure with Chronic Hydrocephalus and Neurological Complications in Young Adult

Case at a Glance

A 26-year-old male presented with his first generalized tonic-clonic seizure, complicated by chronic hydrocephalus, recurrent visual disturbances, and multiple systemic symptoms requiring multidisciplinary evaluation.

Patient's Story

The patient experienced a sudden onset of visual field defect (white-out vision) followed by loss of consciousness with generalized tonic-clonic seizure activity lasting approximately 10 minutes, accompanied by oral foaming and post-ictal confusion with expressive aphasia. Recovery was gradual with persistent difficulty in articulation. For the past two years, he had been experiencing intermittent episodes of visual field defects with associated body spasms, but this was his first progression to a full seizure. The patient also reported concurrent gastrointestinal symptoms including recurrent nausea, altered bowel habits, and hematochezia (up to 250ml blood per bowel movement).

Initial Assessment

Physical examination revealed diplopia in the left visual field and post-ictal neurological deficits. Vital signs showed significant bradycardia (heart rate 40-45 bpm, baseline 80-90 bpm), hypotension (non-critical), and oxygen saturation of 98%. ECG demonstrated new-onset arrhythmia post-seizure. Laboratory results were largely normal except for elevated lactate levels and normal renal function.

The Diagnostic Journey

CT head imaging revealed ventricular dilatation consistent with hydrocephalus, with asymmetric cerebrospinal fluid accumulation more prominent in the right hemisphere, correlating with the patient's left-sided visual field defect. MRI brain was ordered for further characterization. The patient had a significant history of childhood hydrocephalus diagnosed at age 10 without adequate follow-up, and recurrent head trauma from childhood. Additional history included left-sided pelviureteric junction (PUJ) obstruction currently under urological management.

Final Diagnosis

Chronic hydrocephalus with acute exacerbation, complicated by seizure disorder and neurological deficits. The case required specialist consultation due to the complex presentation and unclear etiology of the acute deterioration.

Treatment Plan

Patient was admitted for monitoring and specialist consultation. Due to the complexity of the case and weekend limitations, neurology and neurosurgery consultations were arranged for the following Monday. No immediate antiepileptic medications were initiated pending specialist evaluation. Continuous cardiac monitoring was implemented due to bradycardia and arrhythmia.

Outcome and Follow-up

Patient remained hospitalized with ongoing episodes of visual disturbances, severe headaches described as increased intracranial pressure, and non-convulsive spasms occurring daily. The case was referred to external specialists for further evaluation and management recommendations due to the complex nature of the presentation and local team's uncertainty regarding optimal treatment approach.