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Had compressive craniectomy. CT scan showed changes of gliosis and encephalomalacia on rt frontal temporal. Treatment?

Nov 2013
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Practicing since : 1994
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hello sir my brother met with rta 6months back and surgery has been done at that time for edh and as there is no response they did the second surgery that was compressive craniectomy and after that after 30days he gradually open his eyes and moved his limbs and now he is eating semisolid foods and trying to hold his neck as he can do that for few seconds and he is also trying to hold his back and he is looking at us while we call him and also sometimes recognising us.he was unable to speak but making some sounds and he is 22 year old at the time after surgery ct report was like right fronto temporal lesion and now after 6months the ct was changes of gliosis and encephalomalacia on rt frontal temporal and parietal region and also on left side there are changes of gliosis and moderate hydrocephalus my doctor said that about this hydrocephalus there is no shunt needed as the pressure wont increase as we have already done craniectomy there is no relation between hisreports and his phisical findings as he is improving and his rt pupil there is sluggish reaction.please help me what kind of treatment we can afford for him.
Posted Sat, 6 Jul 2013 in Head Injuries
Answered by Dr. Sudhir Kumar 49 minutes later

Thank you for sending the reports of your brother Mr XXXXXXX

Based on your description and CT scan reports, your brother had very severe head injury, and due to the efforts of his doctor and you all, he is improving well.

I agree that the CT scan changes are related to the old injury and operation, and no new treatment including surgery is required for him right now.

At this stage, the only medicine required for him is anti epileptic medications, to prevent fits.

He needs good physiotherapy, speech therapy, good feeding, etc.

He would gradually recover, as he is young also.

Please get back if you have any more queries.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, Hyderabad
Above answer was peer-reviewed by
Follow-up: Had compressive craniectomy. CT scan showed changes of gliosis and encephalomalacia on rt frontal temporal. Treatment? 1 hour later
thank you so much sir for your reply..we used to give him tab.levipil500mg but as advised by our doctor we discontinued that since past 4 days shall i continue that drug again?he didnt get fits till now but some times when we turn his head suddenly or when we make him sit for a while and let him lie down he is getting nystagmus and clenching his tooth for 2-3 seconds only.we are planning to take him to NIMHNS banglore for stemcell therapy. is it advisable?can you please advise me the diet to be give and in what present we are giving him liquid diet 2ndhrly with the helpof peg and we are give oral feeds at the same time not much but upto 100ml semisolid and liquid.
Answered by Dr. Sudhir Kumar 7 minutes later

Thank you for getting back with more details.

It is better to continue the medications to prevent fits, as his CT scan has shown significant damage. And also the symptoms you have described could be suggestive of Minor complex partial seizures. Oxcarbazepine may be better than levipil.

Stem cell therapy is only experimental at this stage, and has no proven benefit. So, I would not recommend it. However, you may take him to NIMHANS for opinion and evaluation.

Feeding at present seems to be adequate.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
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