A.M. Milani Priyangika 20 years Presented with 2 episodes of genaralised tonic clonic fits.First episode in October 2011.

Second episode 2-3 weeks later.She has no significant past medical history.She was delivered by normal vaginal delivary at term.Birth was uncomplicated.No intrapartum or postpartum complications.Until the age of 8 months development was age appropriate.At the age of 8months child had a severe head injury has had a dispute with her mother regarding the paternity of the child.She was admitted to the local hospital.Child has had LOC on admission.She was ttransferred to the nearest GH.Child recovered.CT Brain not done.After this child got R/UL and R/LL weakness.And she has reduced vision in the L/eye.Currently she is taking Sodium Valproate 200mg B.D for fits.She is coming from a poor socioeconomic family.Her father and mother both being labourers.Her father has died 10years ago due to an Asthma attack.She is the third child .She has married elder brother,married elder sister,married younger sister,and unmarried younger brother.Currently she lives with her mother and younger brother.In the day time both the mother and the brother go out for work.At the age of 10 years she was raped twice by two relatives.She studied up to grade 5 and stopped schooling due to economic problems. O/E She is 43kg and height of 149cm.She has R/hemiplegic gait. CVS:- PR:-84/min BP:-100/60mmHg DR no murmurs RS:-NAD Abd:-NAD

CNS:-Apart from having Bilateral lateral diplopia and 6/36 vision in the L/eye CNS is normal. Cerebellum:-NAD UL:-R/UL and R/LL is hypertonic having power of 4(-) and exaggerated reflexes with normal sensations.R/foot plantar reflex is eqivocal.L/UL and L/LL are normal.

CT Brain Report Moderate enlargement of R/cerebral hemisphere compared to small L/cerebral hemisphere is noted.Ipsilateral lateral ventrical is mildly enlarged than the L/ventrical.No evidence of gray matter heterotopia.Sulci and gyri of both hemispheres are normal.Gliotic changes of white matter is noted in supermost part of the parietal lobes centrally.No evidence of enhancing mass lesions in the brain.4th ventrical and lateral ventricals appear prominent. Comment:-CT appearance favour unilateral Hemimegalencephaly.