Saif

CASE
PRESENTATION
By Dr. Saifullah Chang
House Officer
Pediatric department GMMMC
HISTORY:
 21 days Abdul Kabeer S/O Shahnawaz
Muhammad Naveed R/O Sukkur ,
vaccinated according to EPI schedule;
presented to us with complain of
 Fits
 Fever 5th day of life
HOPI:
 Fits were sudden in onset just after birth,
generalized tonic clonic in nature with up rolling
of eyes , continued for 6 hours in duration,
multiple attacks with interval of 15 minutes
apart
 Baby taken to private hospital , went under
treatment and discharged on tab. Pheno

 Then developed fits and fever at 5th DOL
 Fits were of same nature
 Fever was sudden in onset, high grade ,not
associated with rigors and chills or respiratory

distress , relieved by injectable medications
given at peads emergency
BIRTH HISTORY
…
ANTENATAL:
 Mother was young aged approx. 18 years with
good nutritional status and healthy background
 No any history of chronic maternal illness
 Booked case
 Vaccinated for tetanus
 Multivitamin supplements during pregnancy
 5 U/S were done at 3rd 6th 7th 9th months
respectively all were normal showing single

intrauterine fetus with adequate growth ,
cardiac activity and liquor
 No history of leaking and P/V bleeding
 No any adverse previous obstetric outcome

NATAL:
 History of prolonged labour one hour in
duration
 Trial taken by dia at home
 Emergency cesarean section was done at
local private setup

POST NATAL:
 History of delayed cry, after one hour of birth
 Suctioning and tactile stimulation was done
 Resuscitation was done in OT
 Baby developed fits after then
 Incubated for 4 days at private setup
 No history of jaundice and skin rash

FEEDING HISTORY:
 Breastfed at 5th D.O.L
 No any history of early introduction of enteral
feed
FAMILY HISTORY:
 Firstbaby
 no previous issue
 History of child with cerebral palsy in
paternal side of family

ON EXAMINATION:
An ill pale looking

lethargic baby, on Vitals
oxygen support • HR:128 B/P/M
through nasal • RR:46 B/min
cannula , • Temp:99.8F
cannulated on left • FOC:38 cm
foot , lying on bed • Anterior fontanel:
poorly responsive bulging and tense
• Weight: 2.5 KG
to tactile • Sub vitals
stimulation , not • A+ J- C- D+ E-
crying well
SYSTEMIC EXAMINATION:
CNS:
 Poor primitive reflexes
 Poor Moro, poor sucking, rooting, grasping
 Tone was increased

CHEST EXAMINATION:
On inspection: normal chest movements
with respiration
On palpation: no tenderness, mass,
crepitus
On percussion: resonant note
On auscultation: B/L clear, N/V/B
ABDOMINAL EXAMINATION:
On inspection: normal symmetry normal
movement with respiration
On palpation: no tenderness, rebound
tenderness ,mass , no viceromegaly
On percussion: tympanic note
On auscultation: bowel sounds were
audible
CARDIOVASCULAR
EXAMINATION:
 Normal 1st and 2nd heart sounds
 Apex beat palpable at 5th intercostal space
 No any added sounds

ON INVESTIGATIONS:
CBC showed
 Hb: 9.6 mg/dl
 WBC: 11500 mg/dl
 Plt: 210,000 mg/dl

SERUM U/C/E SHOWED
 Urea: 52 mg/dl
 Creatinine: 0.3 mg/dl
 Sodium: 122.5 mg/dl
 Potassium:5.9 mg/dl
 Chloride: 85.1 mg/dl
 Calcium: 9.7 mg/dl

IMAGING:
U/S showed
 Moderately dilated all four ventricles
 Intraventricular septation
 Edema of brain parenchyma

DIFFERENTIA
L DIAGNOSIS
…?
DIFFERENTIAL DIAGNOSIS:
 Hydrocephalus
 Meningitis
 Encephalitis
 Chronic haemolytic anemia(thalasemia)
 Rickets
 Osteogenesis imperfecta
 Epiphyseal dysplasia
HYDROCEPHALUS
 Defined as, congenital or Acquired disorder in
which there is excessive Accumulation of CSF
within cerebral ventricles.
 There are two main types of hydrocephalus
I. Communicating (Non obstructive)
II. Non communicating ( Obstructive)

ETIOLOGY
Congenital
 Congenital aqueductal stenosis
 Dandy walker malformation: Massive Dilation
of fourth ventricle which obstructs Csf flow &

there is hypoplasia of cerebellar vermis
 Arnold chiari malformation type II: The
cerebellar tonsils are displaced downward

and obstructs the Csf flow .
 Archnoid cyst or congenital tumours
 Intrauterine infections like CMV, Syphillis ,
toxoplasmosis
ACQUIRED HYDROCEPHALUS
 Secondary to infections of nervous systems
e:g Bacterial meningitis

 Brain tumours
 Archnoiditis secondary to bleeding into

subarchnoid space from a ateriovenous
malformation , aneurysm or trauma.
 IntraventriculAr haemorrhage in preterm

infants.
PHYSIOLOGY
CAUSES
 Increased production of CSF
 A block in CSF flow
 Impaired absorption of CSF


 Most common mechanism for producing

hydrocephalus is impaired absorption of Csf
due to obstruction of flow or dysfunction of
absorptive mechanisms.
SIGNS & SYMPTOMS
 There are signs & symptoms of primary
process I,e Infection , trauma,bleeding
 May be sign & symptoms of raised
intracranial pressure secondary to normal

pressure hydrocephalus.
 NonSpecific symptoms
 Headache, vomiting personality & behaviour
changes ( irritable lethargy drowsiness)

 Nonspecific signs
 3rd and 6th cranial nerve defecit, paresis of
extraocular muscles leading to diplopia ,

there may be papilledema.
 Sunset Sign:produced by paralysis of upward
gaze & results in sclera being visible above the iris
 In an infant accelerated rate of enlargement of

head is prominent sign.
 Spasticity first develops in lower than upper in
ascending pattern due to stretching of motor nerve

fibers around lateral ventricles.
 There may be bibniskis sign , brisk tendon reflexes
& clonus.
 Cracked pot or Macewen Sign
INVESTIGATIONS
 X-ray
 CT scan
 MRI
ON CT
NON COMMUNICATING
HYDROCEPHALUS
TREATMENT
 Includes specific therapy for any undertling

disease ie(meningitis ,brain abcess, tumour)
 Medical therapy to decrease Csf production

in slowly progresssive hydrocephalus
includes Acetazolamide,foursemide &
glycerol.
 A ventriculo peitoneal shunt is created
between ventricles and peritoneal cavity is
the most effective surgical method of
treating hydrocephalus
 Complications of shunt are mechanical
obstruction of shunt are mechanical

obstruction of shunt are meningitis or
ventriculitis . Common organism is staph
Epidermidis

Saif

Uploaded by

Copyright:

Available Formats

Saif

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Saif

Uploaded by

Copyright:

Available Formats

CASE

treatment and discharged on tab. Pheno

 Fits were of same nature

 Fever was sudden in onset, high grade ,not

associated with rigors and chills or respiratory

 Vaccinated for tetanus

 Multivitamin supplements during pregnancy

 5 U/S were done at 3rd 6th 7th 9th months

respectively all were normal showing single

 No any adverse previous obstetric outcome

 Emergency cesarean section was done at

local private setup

 Resuscitation was done in OT

 Baby developed fits after then

 Incubated for 4 days at private setup

 No history of jaundice and skin rash

 History of child with cerebral palsy in

paternal side of family

An ill pale looking

 Tone was increased

 No any added sounds

 WBC: 11500 mg/dl

 Plt: 210,000 mg/dl

 Sodium: 122.5 mg/dl

 Chloride: 85.1 mg/dl

 Calcium: 9.7 mg/dl

 Edema of brain parenchyma

 Chronic haemolytic anemia(thalasemia)

 There are two main types of hydrocephalus

I. Communicating (Non obstructive)

II. Non communicating ( Obstructive)

 Dandy walker malformation: Massive Dilation

of fourth ventricle which obstructs Csf flow &

cerebellar tonsils are displaced downward

 Intrauterine infections like CMV, Syphillis ,

 Archnoiditis secondary to bleeding into

 IntraventriculAr haemorrhage in preterm

 A block in CSF flow

 Impaired absorption of CSF

 Most common mechanism for producing

intracranial pressure secondary to normal

 Headache, vomiting personality & behaviour

changes ( irritable lethargy drowsiness)

 3rd and 6th cranial nerve defecit, paresis of

extraocular muscles leading to diplopia ,

 In an infant accelerated rate of enlargement of

ascending pattern due to stretching of motor nerve

 Includes specific therapy for any undertling

 Medical therapy to decrease Csf production

obstruction of shunt are mechanical

You might also like