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Can you create three differential diagnoses for A 61-year-old African American male was admitted following being found down with questionable seizure like activity. The patient has a history of documented seizures with history of medication noncompliance. On arrival he is a GCS of 10 (3,2,5). He is responsive to physical but not verbal stimuli. His pupils are unequal left 2 mm, sluggish and right 4 mm nonreactive. He is also noted to have increased tone in bilateral upper extremities with decorticate posturing. The patient is non-responsive to questions and does not follow commands. Family is not at bedside.The patient was brought in by EMS after being found down for unknown amount of time. He was noted by EMS to have bleeding from bilateral nares and a 3 cm left superolateral scalp laceration. The patient appeared post ictal on arrival. His clothing visibly soiled with feces and urine. He opens eyes to name, localizes to physical stimulation, but does not respond verbally to questions. Per EMS, GCS was 10 (3,2,5) with sys BP in 140's. Family reports she has "been out of seizure meds for a while." Valproic acid was < 10 and initial CT scan shows left subdural and scattered.
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