Maral - Cerebral palsy (Uruguay) Posted on March 16, 2012
Name: Maral Karina Zulamian Koundahdjian 
Sex: Female
Country: Uruguay
Age: 5
Diagnosis:Cerebral palsy
Admission Date: 2012-02-10
Days Admitted to Hospital: 28
Before Treatment:
The prenatal examination results for Maral's mother were normal. The pregnancy was full-term and Maral weighed 3.4Kgs at birth. There were no abnormalities with the birth. She was able to cry normally. The day after Maral was born there was some slight twitching in the arms that persisted for about 3 to 4 seconds each time. The twitching in the right arm was a little more pronounced. She wasn't given any treatment for this brief symptom. She would cry often and was easily frightened during her first year. Her sleep patterns were normal. It was noticed that she had difficulty controlling the movements of her head when she was about a year old. Maral was first able to sit up when she was about 2 and a half years old. Her mental development was delayed and she was only able to communicate with simple sounds, but no words. Maral's parents often noticed that she would make gestures with her arms suggesting she was panicking but for no obvious reasons. Maral's parents took her to the local hospital where she received an MRI examination, EEG and had her hearing checked. The results were inconclusive and there was no clear diagnosis given. Currently Maral is able to hear sounds but is unresponsive. She has a difficult time communicating with others and can only make simple sounds but she is able to express herself by smiling or crying. Her comprehension ability is low and she can only understand simple statements. She also has a short attention span but can focus her attention on her favorite cartoon show. The eye coordinated movements are poor and her head often leans back uncontrollably. Maral had a difficult time opening her eyes completely, unless she was experiencing fear. She was able to eat normally with finger foods but was unable to use utensils properly. Maral was able to grasp toys with her hands and the movements of her right hand were more flexible. She was able to sit up slowly and maintain a sitting position but she was unable to stand or walk. Maral's parents had to do everything for her including washing and dressing her.
Admission PE:
Pulse rate: 102/min, Br: 20/min, Bp: 90/60mmHg, Weight: 26kgs, height: 101cms. There were no yellow stains or hemorrhagic spots on the skin. The positioning of the eyes is abnormal. There is occasional strabismus. Both palpebral fissures are unable to open completely. The palpebral fissures could open completely when she expressed fear. The heart sounds were strong and the cardiac rhythm was regular, 102/min, with no obvious murmur in the valves. The abdomen was smooth and soft, with no palpable masses. The liver and spleen were not palpable under the ribs. There was no deformity of the arms or legs or vertebral column.
Nervous System Examination:
Maral was conscious and alert, but she has asyndesis. She couldn't cooperate with the examination that tests the calculation abilities, memory or orientation. Both pupils were equal in size, the diameter was 3.0mms. The pupils reacted normally to light stimulus. The coordinated movements of both eyes were poor. There was no nystagmus. The bilateral nasolabial sulcus was equal in depth. The teeth were not able to be shown and the tongue could not be extended out. The neck and all four limbs had flexible movement. The right side was more flexible than the left side. The limbs wasl hyperactivity. The muscle tone of all four limbs was normal. Maral couldn't cooperate with the muscle strength examination. Both hands had strong grasping ability. She could stay in a sitting position by herself. The lower limbs could stretch and bend. She could stand and walk by herself. The abdominal reflexes were normal. The tendon reflexes were normal. The sucking reflex was negative. The bilateral palm jaw reflex was negative. The bilateral Hoffmann's sign was negative. The bilateral Babinski's sign was positive. The Chaddock's sign was negative. Maral couldn't cooperate with the deep and shallow sensation examination. She also couldn't cooperate with the coordinated movement examination.
Treatment:
We initially gave Maral a complete examination, and according to her medical history, symptoms and physical signs, cerebral palsy was considered. She received treatment to expand the blood vessels, improving the blood circulation in order to increase the blood supply to the damaged neurons and to nourish them. She was also given motor functioning training, language rehabilitation training and cognitive rehabilitation training.
After the completion of the treatment, Maral's mood had improved. The irritability had decreased. The motor functioning had improved. She now has better control over her movements when she is on all fours, but still cannot crawl. She has continuous turning over movement ability in bed and is able to turn over to both the left and right side. She can now walk more than 10 meters when somebody assists her and the walking posture is better than before. The strides are symmetrical. Maral is able to enjoy the toys her parents give her, better than before.
Maral's family member emailed to us:
Date: 2012-04-10
"Hello how are.
Maral is a little better, but far from walking and more talking.
Greetings."
Date: 2012-05-30
"Dr. Wang HI, I am writing to inform you that we are leaving little medicine. On Friday we're going to draw blood for girls, then in a few days I will report the results, my question is, whether to order more medicine need to know the result of blood test or you already know which medicines we need.?Just in case, tell me again what are the blood tests we have to Give you the girls.
Also tell them that Maral is much better, pay more attention, wants to walk, although the hand. With respect to speech, not any kind of language development. Well greetings to all in the clinic dr wu.
Thanks"