Post-seizure Confusion and Head Injury

An 18-year-old man with a history of previous seizures, not currently on antiepileptic treatment, was brought to the hospital by ambulance after experiencing a seizure at his workplace, a furniture factory, where he served as an apprentice. On arrival, he was in a post-ictal state and had some head injury (see below) bruising around right flank, and thigh, likely due to the seizure. Approximately 45 min after the seizure, he remained confused, with limited verbal responses (yes/no), and his Glasgow Coma Scale (GCS) score was 13, primarily due to impaired verbal responses. He also sustained a head injury, tongue biting, and urinary incontinence during the seizure. There was evidence of bleeding from his left temple, but it appeared to have stopped (dry blood patch).