C09993299 / invoice 10000

Reason: Seizuring Past Few Months -> Three Today.History:Presented today following 3 x focal cluster seizures during the day. First seizures occured in December 2025 after he possibly had access to weed/weed killer. They are described as focal seizures-  He was seen to be fully conscious however passing diarrhoea, shaking and laying to his side. Further seizure activities were observed on 3rd Jan 2026 where he was shaking and unable to stand. These episodes lasted for a few minutes. Gooreum was taken to his reg vet in Mid January, where full bloods tests were run and was started on Pexion 100mg PO BID. Blood test results were all reportedly normal. Since 3 dd ago, he was observed holding up his LPL and walking sideways, like a crab. He was also seen flexing his neck. Gooreum has otherwise been well in his self with no other concerns reported by owner. Current medications: Pexion 100mg PO BID Examination Findings:General demeanour: BARHR: 112 RR: 20 mm: pink CRT: 1-2Temperature: 38.1Cardiovascular: No murmur and regular rhythm, SSFP Respiratory: Clear BV sound, no crackling/wheezing. Normal respiratory effortGastrointestinal: Comfortable in abdominal palpation. No obvious palpable object in abdomen. Peripheral LN: WNL (submandibular, prescapular, popliteal symmetrical and normal in size)  Eyes/Ears: nil anisocoria, nil nystagmus, nil ocular discharge. Both ear canals hairy, R>L subjectively dirtier and brown ceruminous material presentIntegument: Recently groomed coat - No ectoparasite, skin coat normal. Skin tent NAD.  Oral exam: class III malocclusion (underbite). No obvious occlusal trauma. Generalised mild 1/4 calculus buildup. Mild gingivitis. No other oral lesions present. Musculoskeletal: ambulating/weight bearing normally, no obv lameness on distant exam. Grade 2/4 MPL L, 3 R. No spinal pain,  Gait: Weight bearing on 4 limbs. Normal gait.  Neurological: PLRs and menace wnl , no obv proprioceptive deficits . Menation normal. Gait is normal Rectal exam: Not performed/performed Problem List: Cluster seizures (focal) Medial patella luxation (bilateral, grade 2-3/4) Class III malocclusion (underbite)Assessment: Intracranial (idiopathic epilepsy, infectious [bacterial, fungal, parasitic, protozoal, rickettsial, viral], inflammatory/immune-mediate [necrotising ME, eosinophilic ME, granulomatous ME, steroid-responsive ME], trauma, neoplasia [primary intracranial, metastatis, local extension - skull, middle ear, nasal/paranasal sinus, pituitary], haemorrhagic - trauma, coagulopathy], thromboembolism/infarction)VsExtracranial (metabolic [electrolyte imbalances, hepatic encephalopathy, hypoglycaemia, renal failure], thiamine deficiency, drugs/toxins)Further imaging and CSF analysis is recommended to rule out other causes of seizures. Treatment: Keppra (100mg/ml) 1.7mL PO q8hr (30mg/kg) for cluster seizures Continue with Pexion as previously instructed. Plan: Discussed possibile causes of seizures. Suspect idiopathic epilepsy is on the top of the differential list given his age and unremarkable bloodwork from January 2026. However further imaging is required to rule out other extra / intracranial causes of seizures. Offered monitoring in hospital for further seizure activities with view for neurology assessment on Tuesday. There is an increased risk of further seizure activity within the next 24 hours. Owners elected to continue monitoring Gooreum at home with additional anti-seizure medications. Fees for neurologist assessment was discussed (consult fee $330, MRI usually $6000-7000). Owners may pursue this in the coming weeks.    Vital Signs