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Thread: Methylprednisolone soon to be replaced as treatment of choice for Acutes???

  1. #61
    Senior Member cali's Avatar
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    look at that mary she's super hot!rwar! if only i weren't taken, huh? just messin
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  2. #62
    Banned Faye's Avatar
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    Quote Originally Posted by Duramater
    Hey I am sorry that I am only half-way reading this. Faye you will understand there are three teenagers yelling at me that "we" forgot the x box controllers at their fathers earlier. Am I reading it right that the reason Jason was walking at first is because his infarct was in fact evolving as you were bringing him in? Most of us treat adults. I have seen no evolving strokes in kids but I have in adults. Regardless, its a nightmare and terrible. I will read this thread better tonight after we rectify this "important teenage issue" over here. Take care. Be well,

    Mary
    Mary, yes, the stroke was evolving when I brought Jason in. He walked into the emergency room in a way that is described by Dr. Young's lab as "mud-walking".
    Though most have only treated adults for an infarct, what was clear was that he was neurologically affected and needed emergency treatment. He had wet his pants at home, was shivering and unable to speak. The only sounds I got out of him were the episodes of high-pitched screaming.
    Then after being admitted to the ER he started the decerebrate posturing. When they were taking a CT scan, he started foaming at the mouth and upon return to the ER he started the short bouts of kicking and screaming followed by periods of about 15 min. of relative peacefulness.
    After administration of dilantin there were no intervals of peacefulness anymore.

    No neurologist was called in, and there were several hours before Jason was even transferred to a renowned children's hospital ( which I cannot name due to the confidentiality agreement signed by me).
    Upon arrival there Jason was in coma, yet the PICU doctor didn't even show up until several hours later, only to transfer Jason to Shands hospital in Gainesville, FL. ( I can mention their name because they were dropped from the case since they have sovereign immunity for any mistakes they make, and they too made plenty).
    It was at this this hospital that Jason finally had an MRI. At the time it looked like there was a lesion in the area of the cerebellum, but they weren't sure if it wasn't an artifact.
    Three days later when he woke up from his coma, he had a SPECT and another MRI but no MRA. Jason was already paralyzed from the nose down, with only eye movement remaining.

    Four months later when another hospital agreed to treat Jason with intravenous gamma globulin for the diagnosed ADEM, is when a resident looking at Jason's MRI and said: if this had been an adult, I would have thought that Jason had had a stroke. I was asked if I minded them double-checking the ADEM diagnosis by ordering an MRA.
    When the MRA showed no perfusion in the basilar artery, they asked me if it was ok if they did an angiogram, which is the gold standard in diagnosing basilar artery occlusion from an arterial dissection.
    Last edited by Faye; 01-04-2006 at 12:45 AM.

    "There’s far too much unthinking respect given to authority,” Molly Ivins explained; “What you need is sustained outrage.”
    Kerr, Keirstead, McDonald, Stice and Jun Yan courageously work on ESCR to Cure SCI.

    Divisiveness comes from not following Christopher Reeve's ESCR lead.
    Young does ASCR.
    [I]I do not tear down CRPA, I ONLY make peopl

  3. #63
    wow Faye, I am so sorry to hear what you and Jason had to go through.

  4. #64
    A number of years ago, we published one of the first animal models of basilar artery occlusion. A neurosurgery/neuroradiology resident with superb hands was working in the laboratory at the time. What we found was interesting and explains why basilar artery strokes are relatively rare. Single point occlusions of the basilar artery at any point between the formamen magnum and the circle of Willis did not produce infarcts in the brainstem. However, double-point occlusions produced brainstem infarcts between the two points of occlusion. One of the findings we made was that somatosensory evoked potentials (which can be done in the emergency room) are exquisitely sensitive and reliable indicator of basilar artery occlusion, even when it does not lead to a stroke. Wise.

    [*] Wojak JC, DeCrescito V and Young W (1991). Basilar artery occlusion in rats. Stroke 22: 247-52. The basilar artery is one of the three major sources of blood supply to the circle of Willis. To investigate the effects of basilar artery occlusion, we surgically exposed and coagulated the basilar artery in 25 rats. Basilar artery occlusion at any single point between the foramen magnum and the circle of Willis in 11 rats did not produce histologically detectable infarcts in the brain at 12-24 hours. Two-point occlusions of the basilar artery in 12 rats produced variable infarcts between the occlusion sites but no ischemic lesions elsewhere. After either single- or double-point occlusions, the proximal basilar artery refilled within 2-3 minutes. When the basilar artery was occluded above and below the origins of the anterior inferior cerebellar arteries, the artery segments between the occlusion points initially collapsed but refilled within 2-3 minutes in two rats. Basilar artery occlusions invariably suppressed cortical somatosensory evoked potentials by greater than 50%. Regardless of whether a brain stem infarct developed, somatosensory evoked potential amplitudes recovered to greater than baseline levels by 4 hours in seven of 17 rats and returned to baseline levels by 24 hours in every rat tested. We conclude that the occluded basilar artery receives extensive retrograde collateral blood flow and that somatosensory evoked potentials are exquisitely sensitive to basilar artery occlusion but are insensitive to whether brain stem infarcts develop. Department of Neurosurgery, New York University School of Medicine, New York. http://www.ncbi.nlm.nih.gov/entrez/q...t_uids=2003289
    Last edited by Wise Young; 01-04-2006 at 10:37 AM.

  5. #65

    Jason and John.....

    Faye....

    I do have this similar experience. You know when John was 9 he had diminishing health and was eventually diagnosed with a tumor on the pericardium of his heart. It was choking his phrenic nerve among other things. What it came down to was that he had an impact to his chest while playing sports. Pathologist guessed that he had a bleed and the result was an organizing red cell tumor that developed its own blood supply. Scary thing, it could have ruptured at anytime, and John would have been on a vent if he survived at all. We were very fortunate that Jacquie shared her mycoplasm with him and gave him pnuemonia. What are sisters for? That chest x-ray saved his well being and maybe his life. What I remember most is the way the question marks all hung in the air, and even still no one really knows why he grew that tumor instead of having some horrid stroke or something worse. The tumor was bad enough. I am honored to know you and to have met Jason. John has met Jason as well. I can only say I understand a tiny bit about that churning in your gut that you have. Regardless I hope my John gets a chance to see your Jason again. That experience makes my kid want to study to be able to help kids like yours. Somehow we have to find a way to turn this nightmare around for Jason. You know me already I will never argue politics or ideology here but my God....that day those were two really good looking teenage boys and something about that really made me shiver.

    There is our motivation right there. Hugs to you Faye. You know I don't always see your side clearly but for me it always goes back to seeing my son hand your son a cookie. Thats what matters. That Jason be able to get his own cookies. That's ALL that matters. Thats why we need unity, and a surprising LACK of inbred angst and politics. NO ONE should have to live under these shadows.

    Mary
    1FineSpineRN

  6. #66
    Banned Faye's Avatar
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    Dr. Young, Monique and Duramater, thanks for your caring words. This time of year ( around the anniversary of Jason becoming paralyzed), often is a time of reflection on what happened or rather what didn't happen to save Jason from this devastation.
    I so wish I can save others from going through this.

    Quote Originally Posted by Wise Young
    A number of years ago, we published one of the first animal models of basilar artery occlusion...... One of the findings we made was that somatosensory evoked potentials (which can be done in the emergency room) are exquisitely sensitive and reliable indicator of basilar artery occlusion, even when it does not lead to a stroke. Wise.
    The somatosensory evoked potential test that was done 4 months after Jason was paralyzed seemed rather time consuming..... Glad to hear though that such sensitive tests can be done in the ER too.

    However I think a simple and timely MRI and MRA would have been the perfect solution. Ironically I was an equipment planner at Kaiser Permanente Hospitals in SO. Cal, where I had to determine demand for MRI procedures from our membership and the number of MRI machines we would need. This was when MRI equipment first came to market.
    The golden rule was that when a CT didn't show anything, but neurological symptoms continued, you would immediately follow with an MRI and nowadays also an MRA. So as you can imagine I pleaded with them to save Jason by getting an MRI done, but to no avail.
    The first hospital had just decided to not have MRI services on the weekend, and did not refer to the renowned children's hospital immediately. At the second hospital both pediatric neurologists were on vacation and no MRI was ordered either.....

    Even though transcranial doppler is operator dependent, I still think that just as with heart infarcts, TCD should be available in the ER. A patient who presents with neurological problems could quickly be evaluated, and such prompt diagnosis could easily have helped save Jason from paralysis too.

    "There’s far too much unthinking respect given to authority,” Molly Ivins explained; “What you need is sustained outrage.”
    Kerr, Keirstead, McDonald, Stice and Jun Yan courageously work on ESCR to Cure SCI.

    Divisiveness comes from not following Christopher Reeve's ESCR lead.
    Young does ASCR.
    [I]I do not tear down CRPA, I ONLY make peopl

  7. #67
    Banned Faye's Avatar
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    Neurovascular Critical Care

    Quote Originally Posted by Faye
    Dr. Young, Monique and Duramater, thanks for your caring words. This time of year ( around the anniversary of Jason becoming paralyzed), often is a time of reflection on what happened or rather what didn't happen to save Jason from this devastation. Dr. Young, thank you for your early interest in the basilar artery!

    I so wish I can save others from going through this.


    ...... I think a simple and timely MRI and MRA would have been the perfect solution. Ironically I was an equipment planner at Kaiser Permanente Hospitals in SO. Cal, where I had to determine demand for MRI procedures from our membership and the number of MRI machines we would need. This was when MRI equipment first came to market.
    The golden rule was that when a CT didn't show anything, but neurological symptoms continued, you would immediately follow with an MRI and nowadays also an MRA. So as you can imagine I pleaded with them to save Jason by getting an MRI done, but to no avail.
    The first hospital had just decided to not have MRI services on the weekend, and did not refer to the renowned children's hospital immediately. At the second hospital both pediatric neurologists were on vacation and no MRI was ordered either.....

    Even though transcranial doppler is operator dependent, I still think that just as with heart infarcts, TCD should be available in the ER. A patient who presents with neurological problems could quickly be evaluated, and such prompt diagnosis could easily have helped save Jason from paralysis too.
    Finally the specialty of Neurovascular Critical Care:

    Dear Mrs. Faye Armitage,

    I am sorry to hear that your son had a devastating stroke from basilar artery dissection. This is an uncommon condition and therefore often unrecognized even in most ER. At our stroke center, we have expertise and clinical guidelines for evaluation and management of patients with Brain Attack or any neurological symptoms. TCD was shown to improve the efficacy of thrombolysis therapy in early stage clinical trials. For diagnosis, there are better imaging studies, such as MRI/MRA and CT angiography, for early diagnosis of basilar artery dissection/occlusion.

    There has been significant progress in the treatment of stroke and spinal cord injury. I am as well believed that stem cell research may bring hope to stroke patient in the future.

    Thank you for sharing your experience with me.

    All the best to you and your son!

    Wengui Yu, MD, PhD
    Director, Critical Care Neurology/Neurointensive Care Unit
    UCI Stroke Center

    From: Faye Armitage [mailto:fayeforcure@yahoo.com]
    Sent: Friday, January 06, 2006 10:34 AM
    To: Yu, Wengui
    Subject: Basilar artery dissection leading to occlusion in 7 year old



    Hi Dr. Yu,



    So happy to see the specialty of neurovascular critical care.



    Unfortunately too much delay and lack of proper ER care, caused my son to progress to the locked in syndrome, when he returned to the ER 6 weeks after colliding with another soccer player.



    I am hopeful that clear protocols have been developed and communicated to all ER doc's to avoid this type of devastating outcome in other children.

    Neurological symptoms like decerebrate posturing should be immediately investigated using appropriate imaging techniques to come to the diagnosis of basilar artery occlusion as quickly as possible so that thrombolytic therapy can be initiated.

    How do you feel about the use of TCD in the ER?



    Since you are at UC Irvine, I wanted to let you know that we are hopeful that Jason, who is n! ow 16 years old will recover motor function, given the potential of future stem cell treatments.



    Thank you for all you do,



    Faye Armitage

    Jacksonville, FL

    www.CureParalysisNow.org

    "There’s far too much unthinking respect given to authority,” Molly Ivins explained; “What you need is sustained outrage.”
    Kerr, Keirstead, McDonald, Stice and Jun Yan courageously work on ESCR to Cure SCI.

    Divisiveness comes from not following Christopher Reeve's ESCR lead.
    Young does ASCR.
    [I]I do not tear down CRPA, I ONLY make peopl

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