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    Baby diagnosed with severe neonatal asphyxia, UTI, pneumonia. CT done. Help?

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Posted on Tue, 4 Jun 2013 in Brain Tumor
Question: Dear doctor,

I am seeking help at the request of a desperate mum in China. Her now 4 months old baby was severely choked after vomitting milk when he was 2 months old. And since then, the baby boy, XXXXXX, has been in deep coma for 66 days now. He has been diagnosed severe neonatal asphyxia, and is now kept alive on ventilator, having very weak spontaneous respiration, bronchopneumonia, anemia.

Revealed by XXXXXX head CT examination on 18/03/2013, he had a small amount of subdural effusion. However, on 11/04/2013, his head CT revealed that it had accumulated to be a large amount. XXXXXX was then diagnosed communicating hydrocephalus. But his doctor didn't do anything until 25/04/2013. XXXXXX was then put on traditional Chinese medicine to control the fluid. OnXXXXXXlatest head CT (08/05/2013, CT report is attached below), it seems the accumulation has been controlled, however, there's bleeding. XXXXXX parents, advised by another doctor, requested a shunt/drainage operation to induce the fluid out. However, they were informed by XXXXXX doctor that this operation is of no use to XXXXXX. He said the effusion is caused by XXXXXX brain atrophy, not external hydrocephalus, and it didn't cause intracranial hypertension or swelling of the brain. Even induced out, the fluid would accumulated again very quickly. However, the other doctor thinks that there is intracranial pressure, and this operation should have some positive effects.

XXXXXX parents are confused now. They on one hand more inclined to the second doctor's opinion and would like the operation to be done, but on the other hand could not persude XXXXXX doctor to do it. So, at their request, I am helping them to seek a third opinion here. Their main concerns are:

1) Is it beneficial or not to do the shunt/drainage operation in XXXXXX case?
2) Are there any serious risks?
3) If the risks outweigh the benefits, are there any alternative treatments?

I attached XXXXXX latest CT report below. How can I attach the CT scans as well? It's too big for the attachment.

XXXXXXX parents and all the people who love XXXXXX appreciate your help so much! Thank you!

Kind Regards,

XXXXXX



XXXXXX CT report on 08/05/2013 (translated from Chinese):

Name: XXXXXX
DOB: 01/01/2013
Examination date: 08/05/2013

Clinical diagnosis:
1. Hypoxic ischemic encephalopathy?
2. Brain hernia?
3. Anemia
Examination: craniocerebral multi-slice spiral CT

Examination result:
A large density zone of cerebrospinal fluid can be seen below the XXXXXXX lamina on both sides of top frontotempral, and beside the brain lian. Small patchs of high density shadow can be seen inside with according gyrus compression shift. Symmetric left and right cerebral hemisphere. Clear boundary of gray matter. No obvious abnormal density shadow in the right brain parenchyma. Enlarged ventricular system. Widened sulci, fissure, and cisterns. No shifting of midline. Swelling in both sides of the top scalp. Increased density in both eardrum-mastoids.

Impression:
1. Large subdural effusion and a small amount of bleeding below the XXXXXXX lamina on both sides of top frontotempral, and beside the brain lian; Communicating hydrocephalus; Compared with the CT result on 11/04/2013, there's no obvious changes except a small amount of subdural bleeding.
2. Effusion in both eardrum-mastoids.
3. Hematomas in both sides of the top scalp?
doctor
Answered by Dr. Praveen K Nath 16 hours later
Dear sir/ma,am
Hello & my best wishes for a speedy & complete recovery of baby.

I have gone through history of baby given by you in detail.

He seems to be in hypoxic encephalopathy with pneumonitis & septicemia.

CT scan reveals almost static subdural hygromas & ventriculomegaly with no obvious mid-line shift or periventricular ooze.

I suggest

1. decompressive/shunt surgeries may not help much in cases of hypoxic encephalopathy, as the brain has been diffusely damaged due to hypoxic insult .

2. we can continue with ventilator support, antibiotics, anti-oedema measures like i/v mannitol, glycerol, etc.

3. get repeat CT/MRI BRAIN to see increasing hydrocephalus/ subdural hematoma. Surgery may be done in case of increase in pressure

4. as such prognosis of hypoxic encephalopathy in kids is not good


You can always send your CT SCAN images online as individual images in JPEG format .

Hope this answers most of your queries

Thanks

Wishing a speedy recovery

Dr Praveen K Nath XXXXXXX consultant neurosurgeon
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Praveen K Nath 2 hours later
Dear Dr. XXXXXXX XXXXXXXXXXXXX

Thank you for your reply. I have uploaded the CT scans to my photo space, and the link is here. Could you please have a look? because the report is translated from Chinese, and may not be very accurate.
WWW.WWWW.WW
You mentioned 'Surgery may be done in case of increase in pressure', is the increase in pressure measured by the increasing volume of the fluid?

I am a bit lost what made you think the baby seemed to have septicemia? Not mentioned by his doctor...

Thanks again,

XXXXXX
doctor
Answered by Dr. Praveen K Nath 20 hours later
Dear Sir
Hello

I have gone through your query in detail.
CT scan images are not opening up at your link. You can re-send individual images in JPEG format.

Secondly, rise in intra-cranial pressure is measured through repeat CT scans by assessing increase in size of fluid/ midline shift, etc.

Thirdly, baby seemed to have septicemia because he has broncho-pneumonia & neurosurgeon

Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
Answered by
Dr.
Dr. Praveen K Nath

Neurologist, Surgical

Practicing since :1996

Answered : 146 Questions

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