CT or No CT? Young male with new onset seizure

SEIZURES:

24 year old male is brought to ED by his friends, who had seizure while they were having a dine out at a restaurant. Initially patient developed headache, which was gradual in onset, moderate intensity, got worse with time and resulted into fits. He had tonic clonic fits lasting 3 minutes which terminated spontaneously. Patient had post ictal state; On examination patient was found to have tongue bite and trauma to his scalp with sub galeal hematoma.
CT Brain was ordered and showed following films:

Whats the diagnosis and give rationale.

1. SOL (Astrocytoma, ganglioma, schwanoma,etc,
2. Ischemic stroke
3. Normal CT-Brain
4. Toxoplasmosis
5. No CT should be done, observe and discharge home with instructions

Discuss in comment box please..

Clinical manifestations of severe synthetic cannabinoid toxicity: An Update

Clinical manifestations of severe synthetic cannabinoid toxicity

Synthetic cannabinoids consist of a heterogeneous group of chemical compounds that act as agonists at cannabinoid receptors with 2 to 800 times the potency of delta-9 tetrahydrocannabinol (THC), the active component of cannabis (marijuana). They have emerged as a popular recreational drug in the United States and Europe. In an observational study of a multicenter, hospital-based registry of medical toxicology consultations, over two-thirds of 277 patients with single-agent exposure to synthetic cannabinoids had altered mental status including severe agitation, toxic psychosis, hallucinations, seizures, and coma [1]. Rhabdomyolysis and acute kidney injury were present in approximately 5 percent of these patients. There were three deaths, including a 17-year-old adolescent with sudden death after first-time inhalational use. Thus, unlike cannabis, synthetic cannabinoids have significant potential to cause serious and life-threatening toxicity among recreational users. 

Uptodate Sep 08, 2016

Salicylate Poisoning Mechanism: Learning Toxicology

Salicylates act directly on the respiratory center in the brainstem, causing hyperventilation and respiratory alkalosis.
In addition, salicylates interfere with the citric acid cycle limiting adenosine triphosphate (ATP) production and generating lactate. Due to increased catecholamines and an increased utilization of glucose, fatty acid metabolism increases leading to ketoacidosis.
Finally, salicylates are weak acids and contribute to the acidosis through direct proton donation. These factors contribute to increased ventilation through compensation but would not be expected to cause alkalemia (overcompensation).
Although the metabolic acidosis begins in the earliest stages of salicylate toxicity, the respiratory alkalosis predominates initially, leaving the patient with a respiratory alkalosis, metabolic acidosis, and alkalemia.

Adolescents or adults presenting with respiratory acidosis early after a salicylate overdose likely have a coingested CNS depressants, experience salicylate-induced acute lung injury, or have underlying respiratory disease.

The combination of acute respiratory alkalosis, metabolic acidosis, and acidemia is an ominous finding, indicating a life-threatening salicylate overdose.

Reference: Tintinalli

Lithium Toxicity: Learning Toxicology

A 45ym known with MDP
, on Lithium ,
He took an unknown amount of Lithium to commit suicide .

The following is/are true or false regarding Lithium toxicity :

1-Both hypothyroidism and hyperthyroidism, as well as calcium disturbances secondary to hyperparathyroidism, have been reported with lithium poisoning.

True

2-Flattened T waves, prolonged QTc intervals, and bradycardia are common.

False,
Are rare

3-Phenobarbitone is the first line therapy for seizures. 

False.
Benzodiazepine

4-Patients with acute lithium toxicity are at risk for developing nephrogenic diabetes insipidus (NDI)

False
with chronic toxicity

5-Whole bowel irrigation with polyethylene glycol (PEG) solution are not effective in patients with large acute ingestions .

False
Effective

6-Serum lithium concentrations correlate more closely with clinical signs in patients with chronic toxicity

True
For chronic toxicity

7-The syndrome of irreversible lithium effectuated neurotoxicity (SILENT) consists of prolonged neurologic and neuropsychiatric symptoms following lithium toxicity.

True,
Fact

8-Lithium poisoning is  associated with elevations in cardiac biomarkers and  left ventricular dysfunction.

False
Is not

9-Severe lithium intoxication can cause nonconvulsive status epilepticus, and encephalopathy.

True