Sunday, January 9, 2011

Follow-up: Child with status epilepticus, posturing--and recovery

I posted yesterday about a 3-year-old girl whom we saw several weeks ago whose parents brought her to the clinic after 6 continuous hours of status epilepticus. Soon after our physicians stopped the seizure, she began posturing, a sign of damage deep inside the brain. While we treated her for malaria, viral encephalitis, and bacterial meningoencephalitis (we didn't know which of these it might have been, but we dared not do a spinal tap to check--that can be dangerous if one suspects increased pressure in the brain), she remained at our clinic for three days, comatose, unresponsive except for posturing in response to pain. Then our physicians advised her parents to take her to another hospital that has higher capabilities than our clinic. But we doubted she would recover.

We were wrong. And it's not for the first time--I must learn to be more measured in my doom-and-gloom predictions about sick kids in our clinic. Half a day after I posted yesterday's sad entry, her mother walked in, child in arms, very much awake. She was so cute and lively that I didn't recognize her, but the other doctors and I were shocked when we realized who it was.

Apparently the parents chose not to go to the other hospital and took her home instead. That evening she began to regain consciousness. And now, several weeks later, having received only three days' worth of treatment, she is here with us, wiggling in her mother's arms, kicking at us playfully, and filling the waiting room with her chatter. She doesn't appear to be deaf. According to her mother, she's back to normal. If there is residual damage, it isn't obvious.

I don't know what to say. I thought she was done for. But it's nice to be reminded--especially as an ER doc who often sees people at their sickest--that even the sickest of the sick can recover.

By the way: I asked the patient's mother why they came to the clinic 6 hours after the seizures started, and, for the record, I was incorrect to speculate in yesterday's blog that they delayed because they didn't know they were dealing with an emergency. They knew it, all right. They spent those crucial hours raising the money and securing the transportation to get to our clinic--which is two hours from their home. We sent them home with a dose of rectal diazepam in case it should happen again--in such a remote area, the benefits of self-treatment of such a dangerous condition seemed to us to greatly outweigh the risk.

Tough life out here.

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