Q. A 37-year-old man is witnessed by his family to have a generalized tonic-clonic seizure at a party.
He does not have a known seizure disorder. There is no history of head trauma, stroke, or tumor. The patient is unemployed, married, and takes no medication. Physical examination shows no skin abnormalities and no stigmata of chronic liver or renal disease. The patient is postictal. His neck is difficult to maneuver due to stiffness. His white blood cell count is 19,000/µL, hematocrit 36%, and platelets 200,000/µL. Glucose is 102 mg/dL, sodium 136 meq/ dL, calcium 9.5 mg/dL, magnesium 2.2 mg/dL, SGOT 18 U/L, blood-urea nitrogen 7 mg/dL, and creatinine 0.8 mg/dL. Urine toxicology screen is positive for cocaine metabolites. Which next step is most appropriate in this patient’s management?
B. Intravenous loading with antiepileptic medication C.Lumbar puncture
D.Magnetic resonance imaging
E. Substance abuse counselling