Timofei Rezaev - Encephalitis sequela (Russia) Posted on March 25, 2013

Name: Timofei Rezaev                 
Sex: Male
Country: Russia
Age: 3
Diagnosis: Encephalitis sequela
Admission Date: 2013-02-17
Days Admitted to Hospital: 28 days

Before treatment:
The patient was born by natural labour at 40 weeks. The movement and development was normal after birth. The patient suffered from hyperpyrexia and convulsions one day when he was 1 year old. 1 hour later, the patient was put in a coma. He was sent to the local hospital and was put on a ventilator for breathing. The patient needed a nasogastric tube for eating. 10 days later, the patient  gradually came out of the coma and respiratory function recovered gradually. So the ventilator was left. 3 months later, the nasogastric tube was removed and took food through the mouth. The patient's masticatory function was obviously slowed down and couldn't chew food. He could only take liquid. The motor function of the four limbs and speech function was obviously slowed down. The patient still had discontinuous fever and convulsions. The local doctor gave him sugar hormone for treatment. After treatment, the patient's fever and convulsion was alleviated. At present, the patient had no movement or language. The patient also has poor vision. The muscle tone is higher when he cries. Sometimes, he has convulsions.

Admission PE:
Bp: 85/55mmHg; Hr: 100/min, Br: 22/min. Height: 68cm, Weight: 14Kg. The patient had a moon-shaped face. Central obesity. The skin and mucosa were normal. There was no stained yellow in the skin and mucosa. There was obvious opisthotonus. The left hip joint was abnormal. Both knees were outward. The left lower limb was shorter than the right lower limb. The spinal column was bent slightly towards the left side. The thorax was symmetrical. Through auscultation, the respiratory sounds in both lungs were clear with no signs of dry or moist rales. The heart sounds were strong and the cardiac rhythm was regular, with no murmur in the valves. The abdomen was smooth and soft. There was tympanitic notes when drummed. There was slight flatulence in the abdomen. There were no abnormalities in the liver and spleen when palpitated.

Nervous System Examination:
Timofei Rezaev was alert. He had a speech disorder and could only say "e-ya" sound. He couldn't cooperate with the examination of memory, calculation or orientation. His comprehension was poor. He had no response when his name was called. He couldn't carry out his parents' instruction. Both pupils were equal in size and round, the diameter was 4.0mms. Both eyes were sensitive to light stimuli. The vision in both eyes was poor. The forehead wrinkle pattern was symmetrical. The bilateral nasolabial sulcus was equal in depth. He had opisthotonus posture. He could rotate his neck left and right when he was in supine position. He tilted his head back obviously in the sitting position. The muscle strength in the waist and back was poor. He couldn't sit or maintain sitting position independently. He couldn't turn over or stand up. Both hands had no grasp action. Both lower limbs had no movement barrier. The knee joints had difficulty with movement. There was toe movement. The four limbs couldn't cooperate with the examination of muscle strength. The muscle tone of four limbs was slightly higher than normal. The abdominal reflexes were normal. The tendon reflex of four limbs was not elicited. Bilateral ankle clonus was not elicited. Bilateral sucking reflex was negative. Bilateral palm jaw reflex was positive. Bilateral Hoffmann sign was negative. The Rossolimo sign of both upper limbs was negative. Bilateral Babinski sign was positive. He couldn't cooperate with the deep and shallow examination. We initially gave Timofei Rezaev a complete examination, and he was diagnosed with Encephalitis sequela. At the admission: the patient's ACTH(8am)1.0ng/L, was obviously lower than normal. The serum Cortisol (8am) 596.5nmmol/L, was higher than normal.

Treatment:
Then the patient received treatment for neural restoration, nerve regeneration, to nourish the neurons and improve the blood circulation in order to increase the blood supply and boost immunity. He, also, reduced glucocorticoid to adjust the levels of hormones. This was accompanied with rehabilitation therapy.

Post-treatment:
The moon-shaped face is not so severe. The patient had better responses and the motor function is improved. He responds when his name is called. Both arms can be lifted. Both hands have a little grasp action. The muscle tone of both upper limbs is almost normal. The range of motion of both upper limbs' joints is better. The flexibility of both upper limbs' joints is better, too. With a state of relaxation, range of motion of hip joints and knee joints reached 60-90 degree. He turned over 90 degree on the left side. At present, the patient takes half the dosage of hormone which he used to take. The levels of hormones in the blood ACTH(8am)1.0ng/L; Cortisol(8am), reduced to 338.1nmmol/L.