Child with terrible vomiting. Had a intestinal blockage and swollen lymph nodes in abdomen. Done MRI and CT scan

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Posted on Fri, 25 Oct 2013 in Child Health
Question: My 8 month old grandson was ill with terrible vomiting for over a week and was seen numerous times by medical professionals and even hospitalized. His parents were told he had a virus. Many of his labs were high including platelets and white blood count. He seemed to finally improve and then all of a sudden became lethargic while at daycare. His parents were then told he had a intestinal blockage and swollen lymph nodes in his abdomen. He hadn't passed stools for several days. He then started having seizures. After an MRI and CT scan it was determined he had subdural hematomas, bilateral frontal hygromas, right transverse sinus irregularity, and a right parietal diffuse image abnormality suggestive of ischemic changes but very subtle. The doctor noted the findings were not definite in themselves of non-accidental trauma but later was ruled non-accidental trauma due to retinal hemorrhaging. However, the only treatment he needed was IV fluids and anti seizure medication. He recovered remarkably. Then in a couple of days he developed a slight fever and rash and returned to the hospital. A CT scan was ordered and they decided the blood clot was getting larger and the fluid from his brain needed drained so he went through surgery. It seems strange to me that when hospitalized this time he was completely normal acting and supposedly had so much fluid building it needed drained. But during the previous hospitalization he was unconscious for days and didn't need any fluid drained or treatment for swelling. Matter of fact no swelling of the brain was ever mentioned. Then after this surgery it was decided that instead of having a "new injury" and "old blood" that he actually had only the "new injury" as what was thought to be the "old blood" was actually just CSF. Also, it was "determined" that the previous vomiting episode for 1.5 weeks was an unrelated illness. How confusing and how can anyone trust the constant changing views?? Also, trying to prove what happened to him and who did it is extremely difficult. He had no other injuries to his neck or spine or any other broken bones, cracks, or bruising. He has always had what appears to be a large head but after looking at medical records it appears his head size did increase in percentiles over time...started out in 25th percentile at birth and then 95th percentile a few weeks prior to onset of illness. I know they are saying non-abusive head trauma but how can that be proven OR does he have something else wrong with him that everybody is missing?? I would hate for this to all happen again because he has an illness or abnormality and he end up sick again or dead.
doctor
Answered by Dr. E Venkata Ramana 1 hour later
Brief Answer:
To discuss the concerns with treating doctors.

Detailed Answer:
Hi,

Thank you for your query on Healthcare Magic.

I went through the medical history of your grandson and I can understand your concerns about his illness and your worry about the chance of its recurrence.

First of all, the initial terrible vomitings could be a manifestation of his brain problem.

Because in brain problems, there will be increase in pressure inside the skull which may lead to intractable vomitings.

Spontaneous bleeding into subdural space may present with subdural hematoma.

Another possibility is development of thrombosis inside the brain blood vessels and venous sinuses because of the dehydration caused by the protracted vomitings which resulted from the virus.

The uncommon possibility is brain infection such as bacterial meningitis, but here child presents with fever, irritability, and vomitings. In meningitis, there is a chance of accumulation of fluid inside the ventricles and subdural space which are known as hydrocephalus and subdural effusions respectively.

Lethargy and seizure is indicative of brain involvement.

Acute event of brain which required hospitalization initially usually present dramatic symptoms such as altered sensorium, loss of consciousness, and seizure.

Here skull can not accommodate the increased pressure inside the brain, so the child presented with symptoms acutely.

Whereas sub acute problems which happen slowly over a time such as accumulation of fluid inside the brain happen gradually, so the child didn't have any symptoms at the second time of hospitalization.

So the accumulation of fluid at second time could be a gradual one which gave time for the brain to adjust, hence there were no symptoms.

Head circumference of 95th percentile a few weeks before the start of illness is a significant and concerning finding and it may suggestive of a chronic subdural effusion or hematoma.

I suggest you to clearly discuss your concerns about the diagnosis, root cause, and its prognosis like recurrence and complications of the child condition and precautions to be taken with the treating doctors.

Hope I have answered your query, if you have any clarification please let me know.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. E Venkata Ramana 15 minutes later
All of these concerns have been discussed with doctors who have treated him. We are getting nowhere. Doctors are dismissing our concerns of his head size saying his head size increased on a curve and nothing drastic. But it jumped percentiles every time he went to the doctor since birth. His birth was c-section and no complications except the cord was around his neck twice.

All we keep getting told is that since he had retinal hemorrhaging it had to be non-accidental trauma. We are also told the illness prior to the onset of lethargy was unrelated. I just find it too coincidental that his head size was large, he had such vomiting without other symptoms, and that his platelet count was high during such vomiting period. However, his platelet count was normal on the day of the lethargy. Additionally, the weekend prior to the 1.5 week long vomiting, he had a fever and was fussy but when he saw a doctor they were told he probably had a virus. So he was sick with fever and fussy for a couple of days, then better for about three days, then had vomiting several times a day for 1.5 weeks, then got better for a day, then went to daycare fine and later had some vomiting, then even later that day at daycare he vomited a lot and became lethargic. Then the next day while in the hospital had seizures.

Any help would be appreciated. I want my grandson to live a healthy normal life and I'm concerned there is something else wrong with him instead of non-accidental trauma.
doctor
Answered by Dr. E Venkata Ramana 57 minutes later
Brief Answer:
Close medical follow up to assess recovery.

Detailed Answer:
Hi,

Thank you for getting back.

Retinal hemorrhage is in favor of non-accidental trauma.

But doctors make diagnosis of a condition by looking at complaints pattern, history, previous medical history, examination findings, and with the correlation of all test results with the clinical features.

Depending on one single finding it is very difficult to conclude.

The treating doctors might have reached to conclusion of non-accidental trauma after analyzing the history of child complaints, findings on clinical examination, and correlating the test results with the child medical history and findings.

Investigation findings will help to some extent to know the root cause for the development of subdural hematoma and depending on their results, one may predict the chances of its recurrence if it is due to other cause than non-accidental trauma.

What I suggest you is to follow regularly with his treating pediatrician. Close medical follow up is needed to assess his recovery and to detect any abnormality at earliest.

His vision, hearing, head size, developmental milestones to be monitored at regular intervals.

Hope I have answered your query, if you have any clarification please let me know.

Wish your grandson a speedy recovery and healthy life.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. E Venkata Ramana

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Practicing since :2002

Answered : 3176 Questions

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