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Washington University Experience | VASCULAR | Hypoxia-Ischemia, fetal-neonatal | Porencephaly | 6A0 Case 6 History
Case 6 History ---- This was the first SLCH admission for this 3 old male child who had a seizure disorder and severe psychomotor retardation since birth. The patient was one of twins delivered after 6 months gestation. He had a patent ductus arteriosus with congestive heart failure, respiratory distress and meningitis at birth. The other twin died at an age of 4 days because of sepsis. This patient remained in the hospital for 3 months. He developed seizures at 9 months of age which were characterized by clonic movements. He received vigorous anticonvulsant therapy including Dilantin, Mysoline, Tegretol and Diamox. ---- He was admitted at the current time because of fever and one day of continuous seizure activity. When brought to the ER, examination revealed a moribund, comatose child with 38.9o C. temperature, shallow respirations and BP 76/40. He was microcephalic. Pupils were 4 x 4, round, regular, reactive to light with sharp discs on fundal examination. There was gingival hypertrophy and hypoplastic teeth. Neurological examination revealed absent pupillary light responses, no OCM, trace corneal reflexes, no motor activity, no DTRs and right upgoing plantar response. He received IV fluids, K supplements and oxygen therapy. A septic workup including cultures of blood, throat and spinal fluid was negative. He was maintained on monitors with no neurologic improvement, and was found dead.
