Child With Terrible Vomiting. Had A Intestinal Blockage And Swollen Lymph Nodes In Abdomen. Done MRI And CT Scan
To discuss the concerns with treating doctors.
Detailed Answer:
Hi,
Thank you for your query on Healthcare Magic.
I went through the medical history of your grandson and I can understand your concerns about his illness and your worry about the chance of its recurrence.
First of all, the initial terrible vomitings could be a manifestation of his brain problem.
Because in brain problems, there will be increase in pressure inside the skull which may lead to intractable vomitings.
Spontaneous bleeding into subdural space may present with subdural hematoma.
Another possibility is development of thrombosis inside the brain blood vessels and venous sinuses because of the dehydration caused by the protracted vomitings which resulted from the virus.
The uncommon possibility is brain infection such as bacterial meningitis, but here child presents with fever, irritability, and vomitings. In meningitis, there is a chance of accumulation of fluid inside the ventricles and subdural space which are known as hydrocephalus and subdural effusions respectively.
Lethargy and seizure is indicative of brain involvement.
Acute event of brain which required hospitalization initially usually present dramatic symptoms such as altered sensorium, loss of consciousness, and seizure.
Here skull can not accommodate the increased pressure inside the brain, so the child presented with symptoms acutely.
Whereas sub acute problems which happen slowly over a time such as accumulation of fluid inside the brain happen gradually, so the child didn't have any symptoms at the second time of hospitalization.
So the accumulation of fluid at second time could be a gradual one which gave time for the brain to adjust, hence there were no symptoms.
Head circumference of 95th percentile a few weeks before the start of illness is a significant and concerning finding and it may suggestive of a chronic subdural effusion or hematoma.
I suggest you to clearly discuss your concerns about the diagnosis, root cause, and its prognosis like recurrence and complications of the child condition and precautions to be taken with the treating doctors.
Hope I have answered your query, if you have any clarification please let me know.
Regards.
All we keep getting told is that since he had retinal hemorrhaging it had to be non-accidental trauma. We are also told the illness prior to the onset of lethargy was unrelated. I just find it too coincidental that his head size was large, he had such vomiting without other symptoms, and that his platelet count was high during such vomiting period. However, his platelet count was normal on the day of the lethargy. Additionally, the weekend prior to the 1.5 week long vomiting, he had a fever and was fussy but when he saw a doctor they were told he probably had a virus. So he was sick with fever and fussy for a couple of days, then better for about three days, then had vomiting several times a day for 1.5 weeks, then got better for a day, then went to daycare fine and later had some vomiting, then even later that day at daycare he vomited a lot and became lethargic. Then the next day while in the hospital had seizures.
Any help would be appreciated. I want my grandson to live a healthy normal life and I'm concerned there is something else wrong with him instead of non-accidental trauma.
Close medical follow up to assess recovery.
Detailed Answer:
Hi,
Thank you for getting back.
Retinal hemorrhage is in favor of non-accidental trauma.
But doctors make diagnosis of a condition by looking at complaints pattern, history, previous medical history, examination findings, and with the correlation of all test results with the clinical features.
Depending on one single finding it is very difficult to conclude.
The treating doctors might have reached to conclusion of non-accidental trauma after analyzing the history of child complaints, findings on clinical examination, and correlating the test results with the child medical history and findings.
Investigation findings will help to some extent to know the root cause for the development of subdural hematoma and depending on their results, one may predict the chances of its recurrence if it is due to other cause than non-accidental trauma.
What I suggest you is to follow regularly with his treating pediatrician. Close medical follow up is needed to assess his recovery and to detect any abnormality at earliest.
His vision, hearing, head size, developmental milestones to be monitored at regular intervals.
Hope I have answered your query, if you have any clarification please let me know.
Wish your grandson a speedy recovery and healthy life.
Regards.