Today, I was asked to do a full neurological examination on a five years old
boy. Now, I was told from the early days in med school that neuro examination
is one of the hardest. I guess that is why I am good at it. I simply paid
attention every time neuro was mentioned! I did a quite good job and the
consultant was happy (actually satisfied) about it. I was proud of myself until
he asked for my differential (meaning: possible explanation for the examination
finding). I went blank for a moment then muttered (while still in blocked mind
land): cool stroke?
Now, if you are standing, please set down. There is nothing as "cool
stroke". But my examination findings, along with the patient history will
explain that "cool" answer.
Farah was four when his parents noticed him waving his hand occasionally
around his right eye, as if he was checking if it is still working. Months
later, he became clumsy. He then, was limping and having difficulty building towers
as he used to do. He even became worse than his little sister in painting. As if it wasn’t bad enough, he started having frequent
seizures.
By the time I examined him, he was almost
paralyzed in the whole right side (hemiplegia. Actually scored 2 in power
examination). And despite being on cocktail antiepileptic medications, he was
still frequently seizing. He seized three times while I was examining him ( I took less than 15
minute ). It was the first time I see someone seizing. Yet I wasn’t scared. Let
me tell you, I am a PANICY person. The reason was, he smiles at me after each attack,
turns to his mother and laugh!
Now you know why I went to blocked
mind land. I couldn't think of anything more rewarding than working with kids. Their
innocence remind you how wonderful life can be ( Wait what? You thought I was
searching for possible causes? I'll take that as a compliment and just leave it
there).
Back to Farah, ( and the disappointed
consultant). It turn out the poor boy
has a rare case of encephalitis (i.e. brain inflammation), called rasmussen's
encephalitis. It is not clear what cause the inflammation. Some think viral
infection, others think it is an auto immune disease. What is know is that it only
affects one brain hemisphere causing the above symptoms. The patient enter a
vicious cycle where the brain inflammation cause seizures, and seizures cause
brain damage leading to more seizures. Some children eventually become
demented.
I was moved by this boy, his smile and his loving mother. I was so moved
that I struggles not to sob as the consultant explained the prognosis.
Sometimes, I wonder how people survive without faith.
Farah happens to be an Arabic name that means happiness.
