Childhood CVA

CHILDHOOD CVA- A CASE PRESENTATION : 

CHILDHOOD CVA- A CASE PRESENTATION SARANG TAMHNE SpR CRESSIDA JONES FY2

PRESENTING COMPLAINT : 

PRESENTING COMPLAINT Called to A&E to see 13 year old boy. Previously fit and well. Sudden onset of feeling dizzy, slurred speech and collapse. Bumped head as he fell. No LOC Drowsy following fall, brought to A&E.

PAST MEDICAL HISTORY : 

PAST MEDICAL HISTORY Nil- but vitiligo patches noted. Full term, LSCS, no neonatal issues Immunisations up to date No medications or allergies Year 9 student- doing well

Family History : 

Family History 6 elder siblings- 1 with learning difficulties, 1 with asthma, 1 received a kidney transplant last year. Mother has diabetes, hypertension and renal problems. Father died of liver cancer.

Examination : 

Examination On arrival in A&E GCS 12/15 (E3, M6, V3) A- maintaining own B- RR-20, Sats 100% in 5L (down to 95% in RA), chest clear C- CR<2s, P-70bpm reg, BP- 108/57 D- GCS up to 14, pupils bilat 3-4mm, reacting to light, fundi- normal discs and vessels. Abdo- soft and non tender. BM- 4.7. E- no signs of head trauma, no rashes.

Examination 2 : 

Examination 2 CNS- difficult to formally assess. R sided facial palsy- UMN type. 8th- obeys verbal commands 9th/10th- uvular movement +, gag weak 12th- NAD R upper limb- decreased tone, power 1/5, brisk reflexes. Appreciates crude touch. L upper limb- normal tone, normal power, reflexes slightly brisk. Appreciates crude touch.

Examination : 

Examination R lower limb- decreased tone, power 3/5, very brisk reflexes, clonus positive, upgoing plantars. Appreciates crude touch. L lower limb- normal tone, normal power, very brisk reflexes, clonus positive, equivocal plantars. Appreciates crude touch. Weak coordination.

Investigations : 

Investigations FBC- NAD, U&Es- NAD, CRP<0.2, Glucose-NAD, LFTs-NAD, Lactate and ammonia-NAD Blood cultures- NAD pH- 7.13, CO2- 6.64, O2- 4.12, BE- -1.9, HCO3- 21.9 INR- 1.2, APTT-NAD, functional ATIII- NAD, functional protein C- NAD, APCR- NAD, Protein S- NAD Factor V Leiden, Prothrombin Gene Variant, ANA, ANCA, Anti DS DNA, Autoantibodies pending. CT at presentation – NAD- no haemorrhage or mass.

Impression : 

Impression Acute ischaemic CNS insult ? TIA ? stroke ? other CNS vascular event ? Acute encephalitis

Management : 

Management Bloods as previously Urine for homocysteines/ amino & organic acids. IV fluids (NBM with NG tube) Cefotaxime IV Aciclovir IV Neuro obs Aspirin (post d/w Neuro consultant) Transferred to RMCH for EEG, Echo, MRI, MRA and rehab.