*Final Report*
Age: Patient is an 18-month boy.
CHIEF COMPLAINT: Perisylvian syndrome/polymicrogyria
HISTORY OF PRESENT ILLNESS: Parents report that "D" has had no recent seizures or spasms. His last seizure occurred over a year ago. He will occasionally startle with loud noises. Parents report that he will extend his neck and flex his arms forward when this occurs. It appears that D has lost 1 pound since his last visit. The dietitian was consulted and met with the parents to discuss methods for increasing D's caloric intake.
CURRENT DEVELOPMENT: D is in EI program where he receives PT and OT. He also receives PT/OT and speech at Beaumont Hospital twice a week each. D has been making small gains in his development. He has started using his upper extremities more frequently. He is reaching out for objects. He is able to roll from side to side. He is using a gait trainer, taking a few steps in physical therapy. He is babbling a few consonants, but has no speech yet.
PHYSICAL EXAMINATION: D weighs 23 lbs; heart rate is 101 and blood pressure 103/66. D is well-nourished, well-developed, in no acute distress. He is alert, interactive and making good eye contact. Of note, he is drooling quite a bit. Lungs are clear to auscultation bilaterally. Heart has a regular rate and rhythm. Abdomen is soft and not tender. On musculoskeletal exam, strength is 4/5 in upper and lower extremities. D has good head and neck control, but very poor trunk control. He has increased tone in his bilateral upper extremities, bilateral lower extremities. NO parachute reflex was noted.
NEUROLOGICAL EXAMINATION: D is alert, interactive. Pupils are equal, round and reactive. Extraocular movements are intact. There is a positive red reflex. Fundi are not well visualized. NO facial asymmetry. Palate elevates with phonation. Deep tendon reflexes are +2 throughout.
PREVIOUS DIAGNOSTIC STUDIES: D has a VMR in November 2006 which was abnormal with a slow background, occasional spike and wave activity was seen in the right temporo-parieto-occipial region. There were ten events by the parents that were not associated with epileptic activity. D had a CT scan in August 2006 which showed PMG along the perisylvian areas of the brain with a moderate degree of ventriculomegaly. There was no evidence of craniosynostosis on this exam. D also has a barium swallow recently which showed no aspiration, but did show some oral motor dysfunction
IMPRESSION: Perisylvian syndrome, polymicrogyria and epilepsy
TREATMENT PLAN: Continue vigabatrin 250 mg in the morning and 500 mg at bedtime. D will be scheduled for a PET scan. Parents are to call with any questions or concerns. D should return to clinic in four months.
Showing posts with label Clinic Letter. Show all posts
Showing posts with label Clinic Letter. Show all posts
Wednesday, February 14, 2007
Monday, July 31, 2006
Clinic Letter
D was follwed up in the clinic today. he is an 11-month old boy being seen in the clinic for infantile spasms. He also has bilateral perisylvian syndrome. He is accompanied by both of his parents. He was last seen in teh clinc on 05/17/06.
He started having seizures at 4 1/2 months of age. His seizures at the time were happening at a frequency of about 10-12 clusters per day and during each cluster, we would have approximately 15 spasms. He was tried at first on Topamax and Klonopin without much affect.
He was seen at Children's and was started on vigabatrin during Feb. of 2006 His parents reported that within a few days of starting Vigabatrin, he had significant improvements, and his last spasm was on 02/14/06, which is two days after starting the vigabatrin. At the time of the last visit, he also used to have daily episodes of blank stares with pupillary dilatation. THe family did not report any episodes of blank stares since he was started on Vigabatrin.
He is attaining his developmental milestones fasher, as per the parents. As per the parents, he has attained good head support; he can sit up unsupported. He stands up with support. He started doing that a month back. He tracks, he recognizes peop.e. He mostly babbles. He has started sayng "Ma". He laughs. He is learning how to drink out of a suppy cup. He is eating mostly mashed food at presen, but he has started eating some solid food.
He is getting OT/PT and is on the Early Intercention program. He also had a recent ophthamology ev aluation. There have been no interval medical problems since the last visit.
He sleeps well. There has been no behavioral abnormalities. He was born full-tern. He weighed 5 pounds 8 ounces. He is on vigabatrin 250 mg in the a.m. and 500 mg at night.
Review of System: Review of systems is negative for 10 systems unless otherwise mentioned.
Physical Examination: We couldn't obtain his blood pressure or heart rate. His height is 76.7, weight 9.6 kg. He was well nourished. His head circumference was 42, which is below the two standard deviations for his age. He had persistent drooling. He was awake, alert. He ws trackign well. He was smiling. He was interactive. He had good eye contact.
His pupils were 3mm reacting well to 2 mm. He had full range of conjugate eye movements. Facee appeared symmetric on smiling. He had mildly increased tone in both upper extremities, but the tone in the legs seemed normal. He had good strength in the limbs. His deep tendon reflexes were 2+ symmetrically. His planars were equivocal.
A review of the previous evaluations showed a VEP and WERG done during 07/11/06. which was normal. He had a VMR during April of 2006 which showed interictally frequent independant spikes in teh right temporal, central and parietal and occassional independant spikes int eh bilateral occipial area. There was one cluster of habitual epileptic spasns, which was manifested as a subtle body jerk. The EEG at this time of this spasm showed diffuse seizure onset.
He had an MRI during February of 2006 whcih showed Polymicrogyria with evidence of cortical dysplasia, predominantly in perisylvian distribution.
Impression: D has infantile spasms. He has been seizure free since vigabatrin was started. We would like to repeat his VMR after the next visit. We have advised the parents to continue the vigabatrin at the same dose.
He has a brain malformation with bilateral perisylvian synfrome and polymicrogyria. Considering that he has microcephaly, we would like to frule out cranial synostosis. We have requested a CT of the head with bony reconstructions to look for cranial synostosis. If cranial synostosis is present, we may have to consider surgery.
We have advised the parents on the importance of PT/OP and continuing with the early intervention program. We also discussed in detail with the family the future prognosis rearding perisylvian syndrome.
He started having seizures at 4 1/2 months of age. His seizures at the time were happening at a frequency of about 10-12 clusters per day and during each cluster, we would have approximately 15 spasms. He was tried at first on Topamax and Klonopin without much affect.
He was seen at Children's and was started on vigabatrin during Feb. of 2006 His parents reported that within a few days of starting Vigabatrin, he had significant improvements, and his last spasm was on 02/14/06, which is two days after starting the vigabatrin. At the time of the last visit, he also used to have daily episodes of blank stares with pupillary dilatation. THe family did not report any episodes of blank stares since he was started on Vigabatrin.
He is attaining his developmental milestones fasher, as per the parents. As per the parents, he has attained good head support; he can sit up unsupported. He stands up with support. He started doing that a month back. He tracks, he recognizes peop.e. He mostly babbles. He has started sayng "Ma". He laughs. He is learning how to drink out of a suppy cup. He is eating mostly mashed food at presen, but he has started eating some solid food.
He is getting OT/PT and is on the Early Intercention program. He also had a recent ophthamology ev aluation. There have been no interval medical problems since the last visit.
He sleeps well. There has been no behavioral abnormalities. He was born full-tern. He weighed 5 pounds 8 ounces. He is on vigabatrin 250 mg in the a.m. and 500 mg at night.
Review of System: Review of systems is negative for 10 systems unless otherwise mentioned.
Physical Examination: We couldn't obtain his blood pressure or heart rate. His height is 76.7, weight 9.6 kg. He was well nourished. His head circumference was 42, which is below the two standard deviations for his age. He had persistent drooling. He was awake, alert. He ws trackign well. He was smiling. He was interactive. He had good eye contact.
His pupils were 3mm reacting well to 2 mm. He had full range of conjugate eye movements. Facee appeared symmetric on smiling. He had mildly increased tone in both upper extremities, but the tone in the legs seemed normal. He had good strength in the limbs. His deep tendon reflexes were 2+ symmetrically. His planars were equivocal.
A review of the previous evaluations showed a VEP and WERG done during 07/11/06. which was normal. He had a VMR during April of 2006 which showed interictally frequent independant spikes in teh right temporal, central and parietal and occassional independant spikes int eh bilateral occipial area. There was one cluster of habitual epileptic spasns, which was manifested as a subtle body jerk. The EEG at this time of this spasm showed diffuse seizure onset.
He had an MRI during February of 2006 whcih showed Polymicrogyria with evidence of cortical dysplasia, predominantly in perisylvian distribution.
Impression: D has infantile spasms. He has been seizure free since vigabatrin was started. We would like to repeat his VMR after the next visit. We have advised the parents to continue the vigabatrin at the same dose.
He has a brain malformation with bilateral perisylvian synfrome and polymicrogyria. Considering that he has microcephaly, we would like to frule out cranial synostosis. We have requested a CT of the head with bony reconstructions to look for cranial synostosis. If cranial synostosis is present, we may have to consider surgery.
We have advised the parents on the importance of PT/OP and continuing with the early intervention program. We also discussed in detail with the family the future prognosis rearding perisylvian syndrome.
Wednesday, May 17, 2006
Clinic Letter
*Final Report*
Date of Visit: 05/17/2006
Medication: Vigabatrin 500 mg tablet, half a tablet in the a.m. and one table in the evening sine last three months (18mg/kg per day)
Medication Tried: Topamax and Klonopin
Allergies: No known drug allergies
Interval History: D is a 9 month old boy who came to the Neurology clinic for follow-up of infantile spasms.
Full-term normal delivery. Birth weight 5 pounds 8 ounces. NO history of admission in the NICU. Seizure onset at 4 1/2 months of age. It started with infantile spasms. He was getting 10-12 clusters a day and each cluster consisted of approximately 15 spasms. The second day after starting the Vigabatrin he stopped having seizures. He was started on 250 mg b.i.d. A month later it was increased to 250 mg in the a.m. and 500 mg int eh evening because off and on he was having dilation of his pupils without any behavioral arrest. The parents have not seen any spasms. His last spasm was 02/14/06, second day after starting Vigabatrin.
He is gaining skills. He has started holding the head better. He started eating solids baby food, sitting up, smiling, laughing, tracking and recognizing people.
He is getting OT and PT 3 days a week. He is also involved in the Early Intervention.
His behavior is good, He is interacting, Sleep is good.
He was seen by an ophthalmologist and his next appointment will be the end of this month.
Past Medical and Surgical History: Infantile Spasms and Developmental delay
Family History: He is the only son of his father. He has four half siblings. Family history is significant for seizures in mom's brother and mom's niece.
Developmental History: He is 9 months old. He can sit with support and babbles. He is interacting.
On Examination: Today his weight is 9.3 kg, height 71.5 cm, heart rate 97 per minute and regular, and blood pressure 100/57. Heart S1 and S2 are heard. Lungs are clinically clear. Abdomen is soft, no mass. Bowel sounds are present. He had a small head, but he is falling sometime. He has no other dysmorphic features. No neurocutaneous stigmata.
Neurological Exam: He is alert, interactive. Pupils are 2mm in size, reacting to light equally on both sides. Visual acuity is good. Field of vision is normal. Fundus is normal. Extraocular movements are normal. No facial asymmetry. Tongue and uvula in center. He has mild drooling of the saliva.
He has generalized hypotonia. Deep tendon reflexes are 2+. No ankle clonus.
Investigations Done: His MRI done on 02/09/2006 showed polymicrogyria with evidence of cortical dysplasia predominately in perisylvian distribution. VMR done on 04/24/2006 for one day showed the background is slow for age. Some segments of the sleep showed hypsarrhythmia. One cluster of habitual events was captured with the EEG showing diffuse seizure onset.
Impression: D is a 9 month baby boy with a falling problem.
1. Brain malformation/bilateral perisylvian syndrome.
2. Infantile Spasms
Date of Visit: 05/17/2006
Medication: Vigabatrin 500 mg tablet, half a tablet in the a.m. and one table in the evening sine last three months (18mg/kg per day)
Medication Tried: Topamax and Klonopin
Allergies: No known drug allergies
Interval History: D is a 9 month old boy who came to the Neurology clinic for follow-up of infantile spasms.
Full-term normal delivery. Birth weight 5 pounds 8 ounces. NO history of admission in the NICU. Seizure onset at 4 1/2 months of age. It started with infantile spasms. He was getting 10-12 clusters a day and each cluster consisted of approximately 15 spasms. The second day after starting the Vigabatrin he stopped having seizures. He was started on 250 mg b.i.d. A month later it was increased to 250 mg in the a.m. and 500 mg int eh evening because off and on he was having dilation of his pupils without any behavioral arrest. The parents have not seen any spasms. His last spasm was 02/14/06, second day after starting Vigabatrin.
He is gaining skills. He has started holding the head better. He started eating solids baby food, sitting up, smiling, laughing, tracking and recognizing people.
He is getting OT and PT 3 days a week. He is also involved in the Early Intervention.
His behavior is good, He is interacting, Sleep is good.
He was seen by an ophthalmologist and his next appointment will be the end of this month.
Past Medical and Surgical History: Infantile Spasms and Developmental delay
Family History: He is the only son of his father. He has four half siblings. Family history is significant for seizures in mom's brother and mom's niece.
Developmental History: He is 9 months old. He can sit with support and babbles. He is interacting.
On Examination: Today his weight is 9.3 kg, height 71.5 cm, heart rate 97 per minute and regular, and blood pressure 100/57. Heart S1 and S2 are heard. Lungs are clinically clear. Abdomen is soft, no mass. Bowel sounds are present. He had a small head, but he is falling sometime. He has no other dysmorphic features. No neurocutaneous stigmata.
Neurological Exam: He is alert, interactive. Pupils are 2mm in size, reacting to light equally on both sides. Visual acuity is good. Field of vision is normal. Fundus is normal. Extraocular movements are normal. No facial asymmetry. Tongue and uvula in center. He has mild drooling of the saliva.
He has generalized hypotonia. Deep tendon reflexes are 2+. No ankle clonus.
Investigations Done: His MRI done on 02/09/2006 showed polymicrogyria with evidence of cortical dysplasia predominately in perisylvian distribution. VMR done on 04/24/2006 for one day showed the background is slow for age. Some segments of the sleep showed hypsarrhythmia. One cluster of habitual events was captured with the EEG showing diffuse seizure onset.
Impression: D is a 9 month baby boy with a falling problem.
1. Brain malformation/bilateral perisylvian syndrome.
2. Infantile Spasms
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