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Child Treated For Seizures. Swelling In Brain And In Coma. Can We Hope Any Positive Changes?

Posted on Mon, 28 Oct 2013

Question: My 10 yr old grandchild had the 2nd of 3 scheduled procedures to stop her seizures. While closing she may have had another seizure which has now caused swelling in her brain. The manitol seemed to work and they have put her in a coma. This happened yesterday afternoon. Would they have her intubated and on a ventilator? (She's in CT and I'm in MI) Does she have any chance of coming out of this mentally and physically intact? When can we hope to positive changes? I am a retired LPN.

Answered by Dr. Sudhir Kumar (17 minutes later)

Brief Answer:
My replies are below

Detailed Answer:
Hi,

Thank you for posting your query, regarding your grandchild.
Based on the information provided, most probably, they would have intubated her and put her on a mechanical ventilator. For reducing brain swelling, in addition to mannitol, hyperventilation (provided by ventilation, under sedation and paralysis) is also very useful.

The chance of coming out of it depends on any brain damage she may have suffered on account of:

1. Any injury related to surgery,
2. Ongoing seizures,
3. Any associated hypoxic injury.

A CT scan of brain and EEG can give us more information.

I hope it helps.

Please get back if you require any additional information.

Best wishes,

Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, Hyderabad,
My personal URL on this website: http://bit.ly/Dr-Sudhir-kumar
My blog: http://bestneurodoctor.blogspot.com/

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (15 hours later)

Thank you. Her ICP has not elevated since 11 am, I believe that is encouraging. Since the window in her skull is at the left temporal lobe where they had placed the monitor leads 2 wks ago. I assume that is where the edema is is presenting. What kind of mental or physical deficits are possible due to the edema in that part of the brain?

Answered by Dr. Sudhir Kumar (4 hours later)

Brief Answer:
Thank you for getting back

Detailed Answer:
It is encouraging to note that her ICP is under good control.

Left temporal lobe is concerned with two important functions- recent memory and language functions (mainly comprehension of spoken words).

If it is only edema, we expect good recovery. However, if there is any tissue damage related to surgery, then, partial deficits in those functions may be expected. In any case, children tend to recover better than older people.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (4 hours later)

What tests do they do to determine brain death?

Answered by Dr. Sudhir Kumar (16 minutes later)

Brief Answer:
Following tests are done for brain death:

Detailed Answer:
For declaration of brain death, following tests are done:

1. EEG- electroencephalogram
2. Apnea test,
3. Oculo-cephalic reflex (Doll's eye maneuver)

In doubtful cases, CT angiogram or DSA may be done to show absence of blood flow in brain.

Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar