request for help for a child with cerebral injury from Peru

Faculty of Medicine - Library visita at
Fri Jan 24 06:05:57 EST 1997

						Lima, january 23, 1997

This is a request for help.

	Our patient is a Five-year-old girl who has had cerebral injury for about
8 months. We do not have a child neurology department, thus we expect you
to give us your valuable opinion about her case.

	We really will appreciate it!

				Sincerely yours

						Luis Montalvan
						Central Army Hospital

	The patient is a 5-year-old-girl. Her disease started on May 25, 1996 
when she accidentaly choked with a tablet within her glotis resulting in
cardiorespiratory arrest with a loss of concience. She underwent  CPR( we
are not sure on the exact time), traqueal intubation, and intracardiac
epinephrine resulting in a favorable response after 25 minutes. She
presented severe cerebral injury, decortication rigidity, seizures, and
paralytic mydriasis. Twelve hours afterwards, she was admited in our
Hospital. During the plane trip she presented coffe-ground vomits.

	At her admission she had Glasgow of 3/15, pinhole, isochoric pupils with a
low light reactivity, and flacid limbs; spontaneous ventilation by a
traqueal tube. The TC showed a diffuse edema ventilation particulary on the
left cerebral hemispherium. Respiratory rate: 40-60 por min, cardiac rate:
170 per min., a high costal, subclavian, subcostal tirage, rhoncus rales,
wheezing, crepitations on both lungs, skin pallor, peripheral cyanosis,
soft pulse. She did not have fever. Arterial gases were: pCO2: 35,59 mmHg,
pO2: 57 mmHg. Chest X-ray did not show lung collapse of pneumothorax.
Acid-base metabolism: pH: 7,23, HCO3: 14,7 mmHg. Sodium 132 mmol/L, Glucose
326 mg/dL, white cell count: 15 000, with neutrophylia and left shiftiny.

	Admission diagnosis was Anoxic-hypoxic encephalopathy, cerebral edema,
respiatory failure, probably due to aspirative bronchopneumonia.

	Therapy: For cerebral edema: mechanical ventilation, osmotic diuretics and
corticoids, as well as cefotaxime and amikacine were given.

	Evolution: At 48 hs of assisted ventilation and osmotic diuretics she
showed consecutive Glasgow records of 3/15, 4/15, until 7/15 ,spontaneous
winking, with no sight fixation, decortication flexion of upper limbs at
pain stimulus, lower limbs rigidity. Bilateral Babinsky was observed. EEG
(05-28-96): "Abnormal bioelectrical activity consistent with encephalopaty
grade III". EEG (06-12-96): "isoelectric". SPECT (06-13-96): "A small area
of hypoperfusion of the right posterior temporal region and a heterogeneous
distribution pattern". LP (05-31-96) showed a pressure of 40 mmHg and a
final pressure of 12 mmHg. Citoquimic studies were normal, inicial pressure
of the following LP on 06-06-96 and 06-10-96 were 9 and 6,5 mmHg,

	After 48 hs of spontaneous ventilation by a traqueal tube she onderwqent a
tracheostomy since extubation was not possible due to her concience status.
Both pCO2 and pO2 are normal, there were no respiratory signs at the

	Metabolic: Metabolic acidosis was corrected after admission with an
adequate hydratation. No acid-base desequilibrium was observed.

	All her glucose records were normal afterward her admission hyperglicemia.
Sodium, Potasium, Urea, Creatinine and anion gap were normal.

	She recieves her food by a gastric tube.

	Now she presents a descerebration rigidity, no sight fixation. Her father
refers that she reacts with a small movement of her upper limbs and head
when he talks to her.

	We are very concerned with this case, she is only a little child , we will
be thankful if you may bring your comments about this case.

	Sincerely yours.

				Luis Montalvan

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Lima - Peru

*If you know someone who can help us, please forward this message to him or
her !!!

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