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Dr. Maldonado
Dr. Maldonado, Médico
Categoría: Medicina
Clientes satisfechos: 8548
Experiencia:  Especialista en medicina familiar. Mas de 12 años de experiencia. Tutor de residentes.
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Hello. Last Saturday my mother was taken to the ER with migraine-like

Pregunta del cliente

Hello. Last Saturday my mother was taken to the ER with migraine-like headaches and vomiting. Because she had a persistent cold that started the week before (she would get better and then get worse), the ER doctor diagnosed her with dehydration and administered some drugs, but when she did not wake up from the drugs after the effect passed, he suspected meningitis, administered ampicillin, and transferred her to a facility with a CT scanner; The CT scan and spinal extraction confirmed that it was bacterial meningitis; however, the specific bacteria could not determined as she was placed in antibiotics once the doctors started suspecting meningitis at least 4-6 hours before the spinal fluid sample was taken; also, although there were no respiratory issues, a ventilation tube was put in place due to neurological deterioration; she was moved from the ER to ICU on Monday night.

By Wednesday her white blood cell count had gone from 30,000+ to 18,000 and she was alert and moving her head (side/side and up/down), hands and feet; she was attempting to smile and following commands. By Thursday her white blood cell count was ~13,000 but she was looking tired and less responsive, although still following commands; on this day a respiratory test was done, which showed she was breathing on her own but the tube was not removed because she could not lift her head and other extremities. Yesterday, she had a convulsion episode around noon after which the drug Atiban (I believe that's the name) was administered to avoid the possibility of another convulsion; also, her white blood cells had risen back to ~20,000 so a stronger antibiotic was ordered, although all tests came out negative (CT with contrast showed no evidence of edema, chest x-ray was negative, and a second spinal extraction also came out normal). When I saw her after this, she could only answer yes or no questions with her eyelids, with her response being delayed and could not move her head, hands or feet, so an EEG was performed.

Today at noon she was barely awake, with the same type of reactions as the day before; By the evening visit, she was asleep. From what I could understand from tonight's conversation with the doctor on duty, the EEG did not seem to show evidence of epilepsy, but it showed a "diffuse abnormality". I asked a few times what does this mean, but could not get a straight answer... at least not one that I could understand. He also said that the convulsion drug was removed and that he thinks a neurological assessment and, possibly another EEG, might be done after the drug drains out of her body in about 48 hours. I expect to get confirmation from the ICU primary doctor tomorrow as to what will be the course of action they will take.

Her blood pressure is a bit high (she has high BP condition and takes medication for it) but it is being controlled; her HR hovers around 100; and the respirator setting is at 11bpm and the readings are above 11bpm.

Based on the information provided here, I would like to understand the following:

1) What does the EEG results mean? What does it mean to have a "diffuse abnormality"?
2) What is the prognosis?
3) What questions should I be asking the attending doctors about her illness, prognosis and/or treatment?

Thank you.
Enviada: hace 7 años.
Categoría: Medicina
Experto:  Etchaguren escribió hace 7 años.
1) and) 2) As you will know the meningitis is the inflammation of the meninge, a membrane that covers the brain. When this happens there are two options: the EEG is almost normal or there are diffuse abnormalities (with theta or delta activity). If these abnormalities are generalised and delta type the prognosis I am afraid that is bad, the brain has been severely damaged.

But without seeing the patient is impossible to make a prognosis.

3) I think you should ask (after the EEG) if there's neurological damage (probably they will answer you that they cannot say anything without awaking her) and if she's going to be able to breathe without ventilation tube when she gets better. However, I think that a total recovery might be difficult.
Experto:  Dr. Maldonado escribió hace 7 años.
Diffuse abnormality is to say that there is a disturbance in the brain that could be encephalitis. The best prognosis is to identify the germ causing it and treat accordingly. Greetings
Cliente: escribió hace 7 años.
What is then a "diffuse abnormality" and what are "theta" and "delta" activities? Thank you.
Cliente: escribió hace 7 años.
Reading this better, I have the following follow up questions:

1) What I understand from the above responses is that a "diffuse abnormality" is a generalized or widespread abnormality, meaning that it is not focused on a specific area of the brain. Is this correct?
2) Can a diffuse abnormality be triggered by certain medications that sedate the brain, such as those medications that treat convulsions, but that once the sedation is eliminated from the system, the abnormality does not show?
3) Is the fact that she convulsed indicative of neurological damage?
4) Finally, what are "delta" and "theta" activities?

Thank you again.
Experto:  Dr. Maldonado escribió hace 7 años.
Ir means diffuse abnormality that is mildly abnormal EEG are not specific to anything in particular and is like a decrease in size of brain waves, indicating brain involvement. This abnormality may be caused by many things: drugs, encephalitis ... The seizure indicates no permanent neurological damage, only that there was some cerebral involvement. Theta and delta waves are a type of EEG waves
Experto:  fernando cruzado escribió hace 7 años.
1) yes. 2) no. in this case abnormalities are caused by infection. 3) yes. damage or electrical malfunction. 4) types of brain waves. unfortunatelly, prognosis of meningitis is not good
Cliente: escribió hace 7 años.
What are the survival rates, full recovery rates and average recovery time?
Experto:  Dr. Maldonado escribió hace 7 años.
Everything depends on the cause, if viral encephalitis usually occurs with recovery and no sequelae
Dr. Maldonado, Médico
Categoría: Medicina
Clientes satisfechos: 8548
Experiencia: Especialista en medicina familiar. Mas de 12 años de experiencia. Tutor de residentes.
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Experto:  fernando cruzado escribió hace 7 años.
but it is bacterial meningitis!