Hemiparesis - Pediatric Oncall

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Rakesh Kumar, Binay Ranjan, Manjul Vijay Department of Pediatrics, Katihar medical college, Katihar...

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	Specialist Answers
Question
Dear sir, I am Iraqi pediatrician.My son 2year old delivered vaginally with cephalhematoma.On the 2nd day apenc spells started many times,he was admitted in hospital for O2,steroid ,AB,luminal.He got discharged after 5 days with no more fits.Now he is 2 year hypotonic with exaggerated reflexes,right-sided hemiparesis.He can sit un assisted but cannot pull himself to sit while he is lying.He can stand for few seconds freely.He can move from one place to another by creeping or rolling. Still when he catches any thing and brings it to the mouth it appears his right arm is weak.He can say few words.He is very concerned about himself,he can remember painful events.He has good vision &know us but never look face to face just rapid glance is enough to see other.What is your opinion about my son ,prognosis&what he needs to help him thank you....?
Answer
Since he has right sided hemiparesis with unexplained seizures in the neonatal period, one would have to rule out metabolic disorders, birth asphxia related events. An MRI of the brain with hearing assessment and eye examination would be a useful baseline test. If MRI is suggestive of birth asphxia, one need not investigate further and only physiotherapy would be required. If MRI is suggestive of a metabolic insult, further investigations for the same in form of urine organic acids, serum ammonia, blood gases and sugar would be required. Anyway start with physiotherapy at the earliest. Back to All Questions

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