-Spinal tap #3 preliminary results are in. Only showing 2 white blood cells. This is down from 81 (spinal tap #1) and 70 (spinal tap #2)
- Sue has slightly more mobility in her arms.
- Sue continues to have focal seizures. Occasionally these focal seizures seem to rattle her. Some of them seem stronger. They do not hurt her but they seem to cause her some distress.
- I thought doctors orders were to take her off of Versad, but she is still on it. This is probably good since seizures are still occurring.
- Not sure how long she can stay intubated without needing a tracheotomy.
Subscribe to:
Post Comments (Atom)
Posts
3 comments:
The LP results sound really promising. I really think this sounds viral. A brain biopsy might help us tell what virus, but frankly, the only anti-viral treatment I know of for viral encephalitis is Acyclovir, so I'm not sure much would be gained by a biopsy. In other words, if it wouldn't change management, there may not be a point in doing it. There are some other anti-viral drugs out there, but I don't know if any of them treat the other forms of viral encephalitis. It might be worth asking the ID doctor about that. If there are other treatable viruses, then either a biopsy or empiric treatment with these other agents might be worthwhile. Herpes still sounds most likely. Sometimes tests can be falsely negative (sometime the specimen can belong to someone else, even).
Recently, I saw a patient in the hospital whom I was sure had Lyme disease. The rash and symptoms looked classic to me. She'd had a Lyme test, and it was negative. But I treated her anyway and repeated the test. Sure enough the test came back positive. Sometimes, clinical judgment trumps everything else. Lab results are just clues-- part of the bigger picture. In Susan's case, the bigger picture clearly points to a viral process, at least from what I can tell, and most likely a virus in the Herpesvirus family.
Meantime, I don't know if they are doing "passive range of motion" to help Susan's arms and legs stay flexible and keep the muscles from atrophying. That is something you can do with her while you are there: just move her joints: elbows, ankles, knees, hips, wrists, etc. Did you try the music?? I think that could also make a huge difference in her recovery. Music seems to tap into something really primal in the brain. I just read about how Parkinson's patients are dancing to music: suddenly they can move whereas before they couldn't. Just touching her would also really help-- I'm sure you're already doing that.
Any news on when the Versed will be weaned off so she can come off the vent??
I'm around today. If you want me to meet w/ any doctors with you, I probably could today. Otherwise, I'm available by phone, as always.
Generally trach early rather than late.we generally trach at about 1 week, 2 weeks max. If it doesn't look like Sue is going to be able to come off the vent by 12-4-08, then I would trach her now. As I am an Otolaryngologist i would prefer having ENT perform the trach. I think we can manage the trach better than General surgery. There is very little downside to trach. Once Sue is off the vent, the tube will come out relatively quickly. the longer the endotracheal tube is in place the more likely she will develop subglottic stenosis from the endotracheal tube cuff pressure on the trachea.
I'm really sorry to just find out about Sue's condition. In reading everything here about the case, I believe the most likely diagnosis is herpes encephalitis. Even though the initial herpes tests were neg, I go by the clinical picture. The 2nd MRI is also suggestive of herpes as well as the LP results. I'm glad she is on the acyclovir and hope she will recover on this. It is good to r/o other viral causes as well and all the zebras out there. I would not recommend a brain bx at this point if she is responding to treatment. I don't think paraneoplastic syndrome is likely.
Lauren Maza, an old friend of Sue's and med school roommate.
Post a Comment