Dear friend,
I can understand your concerns.I have gone through all the patient documents.
Anyways, it is possible that these recurrent episodes of ataxia are related to vestibular system of the inner ear. The history is very suggestive. The recurrent episodes have started with an episode of ear infection. Ear infections can precipitate LABYRINTHITIS. Labyrinthitis can precipitate benign recurrent positional vertigo. Does she have a feeling of her spinning or the place around her spinning?
Vertigo is the feeling that you are spinning or that everything is spinning around you. Benign positional vertigo is also called benign paroxysmal positional vertigo (BPPV). In children with BPPV, It may occur when you move your head in a certain position. The inner ear has fluid-filled tubes called semicircular canals. When you move, the fluid moves inside these tubes. The canals are very sensitive to any movement of the fluid.The sensation of the fluid moving in the tube tells your brain the position of your body. This helps you keep your balance. BPPV occurs when a small piece of bone-like calcium breaks free and floats inside the tube. This sends confusing messages to your brain about your body's position.
So what should you ask your friend to do now?
Consult an ENT specialist. To diagnose this condition, he or she would perform the Dix-Hallpike maneuvre. He/She will hold her head in a certain position. Then she will be asked to lie quickly backward over a table. As she does this, the doctor will look for abnormal eye movements and ask her is she feels like spinning. This test is a simple bedside test. If it confirms the diagnosis, the treatment is also simple.
Why don't you ask them to consult an ENT speicialist and get back to me? If it is not BPPV, then we have to think of rarer and more difficult diseases such as auto-immune, etc.
Regards
Patient replied :
Hello Doctor,
Thank you for elaborating the details of the case and next steps.
Doctor, I did check with my friend it looks the test you referred has been done and the results were negative. I would like to request you to suggest us the next steps. My friend & family is going through lot of emotions, nothing being found and no treatment scares them. Please advice the next steps to proceed.
Thanks,
Purushotham
Dear friend,
I can understand that your friend's family is going through a lot of difficult phase. There are limitations to what we can diagnose over the internet. We need to see the child in person, review the history in detail and do a thorough physical examination.
Short of that, instead of focussing on what the family is going through, let us focus on the child. Why dont you sit with the family and enquire in detail about what happens during each of these episodes? What the child is doing at the time of onset? Who was around and who has witnessed the episodes? What exactly she feels? Does she have any symptoms preceding or after the episode? Does she feel that such an episode is going to happen? I need every clinical detail possible if you need my help. Not only the tests, summaries and reports. Kindly send me videos of the actual episode as well.
Patient replied :
Hi Doctor,
Sorry for the delay, here are the details from my friend.
1. Initially the child is joined in vaishnavi childrens hospital for normal fever.
At the time of discharge suddenly baby unable to walk ,drouse ,nausea
kind of conditions observed so they suggested to go chennai child
trust hospital.
2. In child trust hospital they have done some blood test which we
are not aware of those test .and MRI report was also says normal
3. After 6 days again same kind of ataxia was observed from baby
so again joined in Apollo childres hospital. there they done blood
test,eeg which was there in the file and discharged with normal
condition.
Again ataxia observed with severe condition so joined in
narayanadri hospital. we were there for 4-5 days they also done EEG,CSF,LFT,RFT,and so many
test has done with normal report and discharged from there.on the next
day itself same kind of condition noticed so they suggested to Nimhans
bangalore
4. In nimhans hospital we admitted for nearly 10 days they have done
so many test but every test shows normal report. doctor suggested to
take test during the ataxia condition but baby doesn't get the
condition in hospital so we discharged .later with friend suggestion
we went to Global hospital.
5. In Global hospital they done bera test and some ent test which shows normal so they have given two syrups for one month and asked usto consult only after two months.
when we came to tirupati again same kind of ataxia observed but this time its like speaking more ,getting irritating ,becoming dull and active spontaneously,vomiting etc.
Thats all from my friend, Please let me know if you can guide them well. They live in Tirupati.
They don't mind going to another hospital or doctor for the treatment. I am attaching the video clip and all the results.
Thanks,
Purush Mera
Dear Mr. Purushottam Reddy,
Thank you for the detailed response. I really appreciate your having given me a lot of important information. But, this is a really complicated case of episodic, recurrent ataxia and requires detailed personal evaluation, physical evaluation and a thorough work up.
I shall advise you to meet my colleague, Dr. Anusha Doraisamy (Mobile: 9791029303) at SIMS Hospital, Vadapalani, Chennai with all the reports, MRI films, etc. She is a trained pediatric neurologist and an expert in this area. She would be able to guide you further.
Do get back to me if you need anything else.