Report on Neurosurgical Consultation for the Patient with Aeizures

Today, I have seen your patient, Ahmad Ali Lewis neurosurgical consultation at your request.

Ahmad is a pleasant, right-handed, twenty-three-year-old man who comes with a history of seizure-like episodes beginning in January of 2012. He was born on January 27, 1994. These seizures consist of a sense of unreality and a feeling as though he was observing himself as an actor on a stage before the onset of, or associated with these seizure-like episodes. He has noted a smell of heavy fragrant flowers. He describes the scent of the flowers as slightly unpleasant, almost funereal. Each of these so-called seizure states lasts only a few seconds and is followed by a tremendous feeling of unreality, which is associated with a great fear that he will not be able to move and Ahmad always gets up and walks around afterward to make sure he is not paralyzed.

During the episode, there is no loss of cognitive ability, Ahmad can converse with his girlfriend, and he has virtually total recall for the entire episode. He had episodes as described in January and February of 2012, four in March and five in April. There is no family history of seizures in Ahmads family.

At age 10, Ahmad suffered a mild head injury, and apparently, he was in a moderately severe motorcycle accident about eight years ago, which resulted in a broken mandible.

The neurological examination at this time is substantially normal. The extraocular movements and fundi show no abnormalities. The visual fields and confrontation testing are intact; thus, indicating the lack of Babinski Sign. However, the only anomaly that I could detect in the entire examination was a stiffened right shoulder, which he tells me, came on after a lengthy game of tennis. I could palpate no masses over the head, and there were no audible bruits over the cranium or the carotid bifurcation.

Ahmad has been on a dose of thirty milligrams of Phenobarbital Bid, and I did not care to add any Dilantin. The Phenobarbital keeps him in a drowsy state. Consequently, Ahmad is not able to think creatively or participate in sports activities.

I have reviewed the skull x-rays he brought, and the scan taken at the University Hospital. In my opinion, the skull x-rays and the scan taken at the University are within the standard limits. Moreover, Ahmad came with the EEG records, which I have gone over the enclosed neurologists summary. At this time, I thought there was a slight abnormality present in the right temporal area. However, I do not believe there is evidence of intracranial mass lesion or focal neurologic deficit because Ahmad has total recall for the entire episode. Equally important, evidence shows that Ahmad has no postictal abnormality.

My tendency at this time would be to switch him gradually over to thirty milligrams of Dilantin TID, and in addition, place him on one hundred and twenty-five milligrams of Diamox every morning. I prescribe Diamox because Ahmad told me that the seizures occur when he heads out for his jogging training session.

We have agreed that, if he will not markedly improve within one month on this regimen, he would come into the hospital for four-vessel angiography.

Thank you for the privilege of seeing this patient and for thinking of me in connection with his problems.With kind regards,

Maximous Payne, M.D., F.R.C.P. (C),

905-845-7351