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Maria Mica - West Syndrome

Author Julia Views Posted at 2014/01/14

Name: Maria Mica
Sex: Female
Country: Argentina
Age: 5 years
Diagnosis: West syndrome, Cerebral palsy
Admission Date: 2013-07-09
Days Admitted to the Hospital: 28

Before treatment:
The patient was a premature infant and was born when her mother was 28 weeks pregnant. The patient´s weight was 1.2Kg at birth. The patient suffered from cerebral hemorrhage while crying and screaming when she was 20 days old. The patient suffered from epilepsy when she was 8 months old and was diagnosed with West syndrome. She took oral sodium valproate as treatment. She had not had an attack after 13 months. But the EEG showed there was still an epileptic wave present. The patient underwent rehabilitation every day. Before the treatment, the patient was unable to turn over, sit up, crawl or walk. She had a speech disorder, in which she only could pronounce the sound "A".

Admission PE:
BP: 90/60mmHg, Br: 21/min; Hr: 92/min, Height: 111cms, weight: 14.5kgs. The patient´s diet was poor, and she suffered from developmental retardation. Her skin and mucosa were normal, with no yellow stains. Her thorax was symmetrical. The respiratory sounds in both lungs were clear with no signs of dry or moist rales. The sound of her heartbeat was strong and the rhythm was normal. There was no obvious murmur in the valves. The abdomen was flat, with no palpable masses. The liver and spleen were not palpable under the ribs.

Nervous System Examination:
The patient was alert. She had a speech disorder and only could produce the sound "A". She produced too much saliva. She could not perform the memory, calculation abilities or orientation examinations. Her comprehension was poor and she only could communicate with her parents at a fundamental level. The diameter of the pupils was 3.5mms. Both pupils had sensitive responses to light stimulus. The forehead wrinkle pattern was symmetrical. The bilateral nasolabial sulcus was equal in depth. The movement of neck was poor in supine position. She had difficulty supporting her head in a seated position. She was unable to turn over by herself. The muscle strength of her waist and back was poor. She was unable to maintain a seated position by herself. Both hands were able to grasp objects. She was able to move both lower limbs. She could not lift her legs off of the surface of the bed. She was unable to complete the examination for the muscle strength of her four limbs. The muscle tone of her four limbs was higher than normal. The range of movement of her shoulder joints, elbow joint, hip joints, knee joints and ankle joints was limited. Her abdominal reflexes were normal. The tendon reflex of her four limbs was active. Bilateral Achilles tendon reflex was not elicited. Bilateral ankle clonus was positive. Bilateral sucking reflex was negative. Bilateral palm jaw reflex were negative. Bilateral Hoffmann sign was negative. The Rossolimo sign of both upper limbs was negative. Bilateral Babinski sign was positive. She could not perform the sensory and coordination movement examinations.

After admission, the patient received the relevant examinations and she was diagnosed with West syndrome and cerebral palsy. She was given treatment to improve her blood circulation in order to increase the blood supply to the damaged nerves and nourish the neurons. She also had treatment to enhance her immunity. This was combined with daily physical rehabilitation therapy.

The patient has grown taller and gained weight as well, height: 113cm, weight: 15Kg. The patient suffered from a relapse of otitis media. She took antibiotics to prevent any infection. She also used ofloxacin ear drops in a particular area. The infection was cured in 2 weeks. The patient´s intellect has improved. Her muscle strength has increased and the muscle tone is better than before. She is producing less saliva in comparison to before. When the patient understands what others are saying, she can show she understands by blinking. She has better control of her head. The muscle strength of her head, chest, waist, arms, and legs has increased in comparison to before. She can support herself with her elbow and can raise her head for several minutes. With some assistance, the patient can maintain a seated position for several minutes. With some assistance, the patient can turn over. She can move both of her legs by herself. She can lift her legs off of the surface of the bed. The muscle tone of her whole body has been reduced, as compared to before. The range of motion of in her shoulder joints, elbow joints, hip joints, knee joints and ankle joints has increased. The tendon reflex active index of her arms and legs has declined in comparison to before. The bilateral ankle clonus positive index has also been reduced. The Bilateral Babinski sign was negative.

Date: 2013-08-23
Subject: Maria Micaela Tursi Esteban - Argentina
Thank you so much for the prompt reply Dr. Liu, keep in touch.
On Thursday of next week we will make the lab that you requested, also will come a nutritionist and gastroenterologist tell us the best nutrition for animal protein increase and improve anemia in the best way possible, avoiding complications in the liver by the Mica based medication.
Yesterday I commented that was very good, Mica is gaining attention and response to rehabilitation. In yesterday also was less tired.
I send greetings, and we´ll be in touch.
Rosanna Denisse Esteban.
Date: Wed, 4 Sep 2013
Subject:Argentina - Tursi Esteban Maria Micaela
Hi Lisa, Dr. Liu
How are you, hope fine.
Lisa wanted to let you know that the last file you sent me was correct, but the website of the clinic was not corrected so far.
I send the first laboratory held on Thursday August 29 as requested by Dr. Wu, and tell them that Mica is better, less tired and better controlling drooling. The clonus still present, some days more than others.
The weight nutritionist on Tuesday August 27 and was 15.6 kgs, increased 600 grams more.
Well I hope your instructions regarding the lab, not when they want to perform the next or if we should order some other study.
Rosanna Denisse Esteban


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