Discussions By Condition: I cannot get a diagnosis.

6YRS OLD BOY WITH - BRAIN - neurological illness

Posted In: I cannot get a diagnosis. 2 Replies
  • Posted By: Anonymous
  • April 24, 2007
  • 01:16 PM

I am writing from Dubai, UAE, my son has been suffering since 10 December 2006 from a neurological illness which doctors in the UAE and India have so far been unable to find his successful recovery.
The child is extremely unwell and, of course, his condition is causing enormous distress to my family.

On behalf of my family, I should like to beg one of your experts to examine the attached material and offer an opinion, as far as that is possible without physically examining the boy.

I attach a medical report from the Pediatrics at AIMS in Kochi, India. I also attach MRI scans of the child.

Any help you can give would be hugely appreciated by my family near the end of its tether. Please do not hesitate to contact me if there is any way I can help.

Yours sincerely,

31st*jan*2007
medical*summary
Mohammed*Muhsin,*6yr*old

Case*managed*by*L.*Rajam,*Professor*of*pediatrics***Dr
Vinayan*K.P,*Pediatric*Neurologist,*Dpt.*Of*Neurology
AIMS,*KOCHI
*
Mohammed*Muhsin,*6yr*old*boy*was*admitted*to*our*
hospital*on*24th*December*2006*.*his*symptoms*started
on*10th*dec*2006*when*he*developed*status*epilipticus.
No*fever*then.*Stared*as*(L)*focal*seizures.*No
history*of*rash,*No*similar*history*in*the*past,*no
history*of*diarrhea,*no*history*of*recent*vaccination,
no*history*of*dogbite.*He*was*evaluated*at*Welcare
Hospital*Dubai.*EEG:*®*hemispheric*slowing.*CT*brain
(N).*Discharged*on*Tegretol.*Child*had*normal
sensorium*at*discharge.*He*developed*low*grade*fever
after*he*was*sent*home.*Readmitted*on*14/12/2006*with
recurrence*of*GTCS.*EEG:*diffuse*high*amplitude*delta
and*theta*activity*over*the*right*hemisphere*with
occasional*left*front*temporal*sharp*wave*activity.
MRI*brain*(N).*CSF*study*88*WBC,*85%*ktnogicttes,*HSV
PCR*–*Negative.*TB*PCR*–*negative.*Given*Ceftriaxone
and*acyclovir*for*1*week.*Continued*to*have*focal
seizures,*focal*twitching*of*face*and*altered
behaviour.*Started*on*Phenytoin*and*clonazepam.*Fever
also*continued*with*seizures**increasing*with*every
spike*of*fever.*Septic*work*up*negative.*Discharged
against*medical*advice*on*23*/*12*/*2006*with*the
diagnosis*of*viral*encephalitis.*Child*brought*to*AIMS
on*24/12/2006
*
At*admission:*Altered*sensorium.*No*clinical*seizures.
*
Fundus:*Bilateral*papilledema,*no*focal*deficits.
Bilateral*choreoathetoid*movement*with*orofacial
twitching.*He*was*continued*on
Ceftriaxone/Acyclovir/Mannitol*for*1*more*week.*AED:
Phenytoin*/*CBZ*/*Clonazepam.*EEG*(*26/12/2006*)*:
generalized*non*–*specific*disturbance*of*electrical
function*predominantly*over*the*right*hemisphere.*He
was*given*Ivlg*x*5*days.
*
MRI*(*25/12/2006*)*–*normal*–*On*30/12/2006*rpt*EEG
was*done*due*to*suspicion*of*seizure*recurrence*–*same
findings.*Some*intermittent*high*amplitude*slow*waves
–*suggestive*of*electrographic*seizures.
Phenobrabitone**loded.
*
VEP*(N),*MRV*(to*R/o*CVT)*(N),*(R)*transverse*sinus
hypoplastic.*Rpt*CSF:*10*cells.mostly*lymhocytes.
Mx-negatice.*Urine*metabolic*screening*–*negative.
PBG:*negative.*He*continued*to*have*altered*sensorium
in*the*form*or*restlessness,*no*recognition*or
vocalization.*Bilateral*choreathetoid*movements
persisted.*Fever*spikes*continued.sptic*workup*–
negative.
On**8/1/2007*he*developed*right*focal*seizures,*which
developed*into*status*epilepticus.*He*was*started*on
Midazolam*infusion.*Due*to*electrical*seizure
persistence,*he*was*put*on*Thiopentone*infusion.
Inotrope*support*given.*Electively*ventilated.*At*that
time*Hyponatremia*(Na:*116*Meq/1*and*hypocalcemia*(Ca:
7*mg%)*were*detected.*Serum*phenytoin*levels
decreased.*Subsequently*loaded*twice.*MRi*(*9/1/07*)
abnormal*hyperintense*areas*involving*bilateral
ganglio*thalamocapsular*regions*and*bilateral*cerebral
and*cerebellar*hemispgheres.*Possibility*of*ADEM
considered*and*was*given*IVig/Methylprednisolone*x*5
days.*Possibilitty*of*JE*considered*(JE*serology*in
CSF*sent*to*NIMHANS**(is*negative).*Posibility*of*mitochondrial
encephalopathy*also*considered*and*was*started*on
megamultivitamin*therapy.*Anti*rabies*antibody*titre
in*CSF:*(is*negative).
Thiopentone*was*tapered*off*in*48*hours*and*was
statrted*on*levetiracetam.*Child*was*getting
occasional*seizures*on**these*drugs,*Stopped*CBZ*due
to*leucopenia.*EEG:*continued*to*show*significant
diffuse*electrical*disturbance.*Rpt*MRI*(*15/1/2007*).
Fresh*lesion*s*in*bilateral*cerebellar*hemisphere.
Minimal*resolution*of*basal*ganglia*lesions.*MRI*(
22/1/2007*):*significant*reduction*in*hyperintense
signal*abnormality*in*all*areas.*He*continued*to*have
poor*sensorium,*Ventilator*dependency,*His*fever
spikes*continued.*He*was*on*Meropenem*x*2*weeks.
Changed*to*Cefaperazone*–*Sulbactam.*Papilledemia
persisted.*Opthal*opinion*chronic*papillodemia,
gliotic*changes.*On*25/1/07*developed*hepatitis*?*drug
induced*(SGOT*:*889*IU/I*SGPT:*322*IU/I)*Tapered
phenytoin*added*Topiramete.
EEG*(*30/1/2007*):*Significant*improvement*in*slowing.
Normal*background*rhythm.*Suspicious*epileptiform
abnormalities*in*the*left*frontal*region.
Present*Medication
1.*Inj.*Fosphenytoin*75mg*BD
2.*TAB.*CLONAZEPAM******1/2-0-1
3.*TAB.*PHENOBARBITONE******75MG*1-0-1
4.*TAB.*CARNITINE*300MG*1-1-1
5.*TAB.*BENADONE*40MG*1-1-1
6.*TAB.*BENALGIS*75MG*1-0-0
7.*TAB.*TORLEVA*250MG*1-1-1/2
8.*TAB.*CO.*ENZYME*Q*1-0-1
9.*TAB.*TOPIRAMATE*25MG-0-50MG
10.*SYRUP*ZEVIT*5ML*1-0-0
11.*SYRUP*SHELCAL*10ML*1-1-1
12.*TAB.*RANTAC*150*1-0-1
13.*SALBURAMOL*NEBULIZER*6HRLY
14.*IPRAVENT*NEBULIZER******6HRLY
15.*SALINE*NEBULIZER*6HRLY
on*tube*feeds:*300ml*3rd*hourly
On*mechanical*ventilation*(SIMV)

CONTACT:

Dr.*Vinayan*K.P,*paediatric*Neurologuist
Phone*MOBILE*:*00919447800303*
Phone*:*0091*(484)*2801234,
Fax:*0091*(484)*280*2020
Elamakkara*P.O.*682*026*,**Kochi*–*kerala.
*
Patient*reference*Number*in*Amrita*institute*of
mediacal*sciences:*541597
*
Patient’s*Father*contact:
Ummer
Telephone:*0097150*5910688
DUBAI*UAE

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2 Replies:

  • please visit www.ahummingbirdsguide.com M.E. is an organic neurological disorder it affects the brain and many more body systems Best to you and your family...mommy cat
    mommy cat 1654 Replies Flag this Response
  • Dear Ummer,I have read through everything posted here. The situation with your son sounds very bad. It does seem to me that the hospitals are doing everything I could think of, and trying all kinds of medicines.I will pray for Mohammed, and as I am not Muslim, will ask my Muslim friends to pray for him as well. May Allah be with him, you, and your family. I will pray that he returns in health to your family.Salam,Shula
    Anonymous 42789 Replies Flag this Response
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