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Tifer Murag - Sequelae of brain injury (Azerbaijan) Posted on December 4, 2013

Author Julia Views Posted at 2014/01/08

Name: Tifer Murag

Sex: Male

Age: 6 years old

Nationality: Azerbaijan

Diagnoses: Sequelae of brain injury, epilepsy

Admission date: Oct. 16, 2013

Days admitted to hospital: 28

The patient's mother had a normal pregnancy and the prenatal examination showed no abnormalities. The patient was born through cesarean with full term. The patient received nasal surgery when he was three and half. The patient suffered an accident after an anesthesia. He had apnea. After positive rescue, the patient received tracheotomy and a ventilator was used on him to sustain breathing. He also received treatment to help regain conscious. The patient woke up again gradually but he lost all the cognitive functions and motor functions. The patient's head and eyes swung to follow objects. This was accompanied with epileptic seizure. He took antiepileptic drugs. The patient had slight movement in both hands and both legs. The patient's parents took the patient to many countries for therapy. The patient's condition improved gradually. About 1 year ago, the patient could recognize his family members. He also regained emotional response. The patient's comprehensive ability improved slightly in the last six month. From the onset of disease, the patient's spirit was good. He had low appetite. The sleep quality was still good. He had sphincter disturbances. The patient couldn't take care of himself during the course of the day. He had too much slaver. The patient had logagnosia. He also couldn't turn over, sit-up, stand or walk. He also had frequent epileptic seizure.

Admission PE:

Bp: 86/60mmHg; Br: 18/min, Hr: 92/min. Height: 117cm, weight: 22Kg. The skin and mucosa were normal, with no yellow staining or petechia. The respiratory sounds in both lungs were clear with no signs of dry or moist rales. The heart sound was strong and the heart rhythm was regular. There was no obvious murmur in the auscultatory valve areas. The abdomen was even and soft, with no mass found. The liver and spleen were not palpable under the ribs.

Nervous System Examination:

The patient was alert. He was irritable and had logagnosia. He could not complete the memory, calculation or orientation exams. Both pupils were equal in size and the diameter was 2.5mms. Both pupils reacted normally to light stimulus. Both pupils could move freely. The coordination of both eyes' convergence was poor. His vision or visual field exams were almost normal. The nasolabial sulcus was equal in depth. He could show his teeth and stick his tongue out, his teeth were in the center of his oral cavity, and he had gum hypertrophy. He could move his neck freely. He showed poor muscle strength of the neck while he was in a seated position. All four of his limbs were able to move slightly. He couldn't complete the muscle strength testing. Both upper limbs were in flexion position when he was nervous. Both upper limbs could relax and straighten when he sleeps. The muscle tone of all four limbs was slightly higher than normal. Both ankles joints had contractures. Both hands were able to grasp an object. He was unable to fully turn over or sit-up. He could not stand or walk. The abdominal reflex was weak. The tendon reflex of four limbs was active. The sucking reflex was negative. Bilateral palm jaw reflex was negative. Bilateral Hoffmann sign was negative. Bilateral Babinski sign was positive. The Pussep sign was negative. The Chaddock sign was negative. He could not complete the deep, shallow sensation, or coordination movement exams. There was no sign of meningeal irritation.

Treatment:

We initially gave the patient a complete examination, and according to his medical history, symptoms and physical signs, he was diagnosed with sequelae injury of the brain. He received treatment to nerve regeneration, expand blood vessels to improve the blood circulation and nourishment for the neurons. This was in addition to physical, language and cognitive function training.

Post-treatment:

The patient's emotions are better than before. He has gained appreciable appetite. Height: 118cm, weight: 23Kg. The frequency and length of his epileptic seizures has reduced. He has a better environmental adaptability and cognitive function. He also has a better speed of response now. He has gained a better ability to control his neck, waist and back. He can maintain a seated position independently for several seconds. The muscle tone of all four limbs has been reduced as compared to before. The contracture of his left ankle joint has been alleviated. The quantity of saliva has been reduced compared to before.

 Tifer came to our hospital in November 2013. After treatment: the patient's emotions got better than before. He gained appreciable appetite after treatment. Height: 118cm, weight: 23Kg. The frequency and length of his epileptic seizures have reduced. He has a better environmental adaptability and cognitive function. He also has a better speed of response now. He has gained a better ability to control his neck, waist and back. He can maintain a seated position independently for several seconds. The muscle tone of all four limbs has been reduced compared to before. The contracture of his left ankle joint has been alleviated. The quantity of saliva has reduced compared to before. For further therapy, the patient came to our hospital again on October 22, 2014 for further treatment.

Admission PE:
Bp: 116/72mmHg; Hr: 107/min, Br: 18/min. Height: 122.5cm, Weight: 28.5Kg. His skin and mucosa were normal, with no yellow stains or petechia. The respiratory sounds in both lungs were clear with no signs of dry or moist rales. The heart sounds were strong and the heart rhythms were regular. There was no murmur in each valves. The abdomen was flat and soft, with no obvious masses. The liver and spleen were not enlarged.

Nervous System Examination:
Tifer was alert and suffered from anepia. He was unable to cooperate with the examination of memory, orientation or calculation. He suffered from epilepsy for more than 10 times each day and they were mainly absence seizure. The interval of absence seizure was between 15 minutes to 30 minutes. The absence seizure lasted from several seconds to 15 minutes. Both pupils were equal in size and round, the diameter was 2.5mm. Both eyeballs could move flexibly and the pupils were sensitive to light stimulus. The convergence ability was less cooperation. The vision and visual field were almost normal. The bilateral nasolabial sulcus was equal in depth. The tongue was in the center of oral cavity. This accompanied with gingiva hyperplasia. The neck had normal activity. The support ability of neck was poor when he was in sitting position. His four limbs had slight activities. Both hands have grasp action. He was unable to turn over or sit-up. He also was unable to stand or walk by himself. The muscle tone of four limbs was higher than normal. And both upper limbs presented with flexion. The abdominal reflexes were slightly weak. Both tendon reflex of four limbs was active. Bilateral Rosslimo sign was positive. Bilateral Babinski was positive. He was unable to cooperate with the examination of deep sensation, shallow sensation or coordination movement examination. The meningeal irritation was negative. EEG (in other hospital): bilateral frontal area was main discharge. Head MRI (in other hospital): bilateral ventricles was enlarged, brain atrophy.


Treatment:
We initially gave Tifer a complete examination, and he was diagnosed with sequelae of brain injury. The patient received treatment for nerve regeneration and to activate stem cells in vivo. He was then given treatment in order to expand the blood vessels, improve blood circulation and to nourish the neurons. This was combined with sports rehabilitation, language rehabilitation and cognitive function rehabilitation.

Post-treatment:
After three weeks of treatment, the number of seizures and time of seizures have reduced. He has more than 10 times absence seizure. There is no generalized tonic-clonic seizure. He has better motor function and emotional response. He has more communication with others. He has gained rich facial expression. He has more pronunciation. The muscle tone has reduced. His four limbs has more activities. Both hands have gained better ability to grasp. The balance ability in sitting position has improved.

E-mails:

Date: 2016-2-4

We are sorry for this long silence about Timur's condition. We continue the medical therapy accodring to your last recommendations. The overal epilepsy condition  of my son has improved significantly since our visit to your hospital in November 2014. The
attacks happens very seldomly ( once in 1 or 2 months) and the are short. We are planning our visit to your hospital at the end of this year.

During this period Timur's weight increased up to 40 kilo  and the height increased up to 140 sm. We kindly ask you to look through his last blood analisys and maybe update your recommendations accordantly ( please, find in the attachement).

Thank you in advance
Julia Dronova
Mother of Timur Muradov 
 

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