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case № 0012
Diagnosis:

Diagnosis - residual effects of cerebrovascular accident (in 2008) - spontaneous intracerebral hemorrhage in the right temporal area with ​​rupture in liquor spaces. Posthemorrhagic liquor cyst of the right frontal area without displacement. Left-side hemiparesis. Symptomatic epilepsy. Retardation of speech II st. Kyphoscoliosis. 

Case description:

Date of birth - 08.09.2008

 

Complaints  -  myoclonic seizures, which occur at night, restlessness at night, gate disturbance, emotional lability.

 

Second child in the family, from immediate delivery, which proceeded without complications. Discharged from the hospital on the 3rd day. At 2 months the child's mother noticed fever and vomiting, then seizures. Was suspected tumor of brain, were phenomena of intracranial hypertension and focal neurological symptoms. The dynamics on CT, MRI - hemorrhage, resorption of hemorrhage.

 

Clinical diagnosis - spontaneous intracerebral hemorrhage in the right frontal and temporal lobes of the brain with ​​rupture in liquor spaces. Posthemorrhagic liquor cyst of the right frontal area without displacement. Left-side hemiparesis. Liquor cyst in the right frontal lobe was drained.

 

Medicamentations -  Depakine, Gidazepamum. Periodically undergoes rehabilitation.

 

Neurological status at the moment – In consciousness, the contact is available. Emotionally disinhibited. Hemiparetyc walk; during walking - internal rotation of the left foot. Posture - kyphoscoliosis. Self – serving skills - eating, getting dressed by her own. Tendon reflexes - D> S from the hands and lower extremities.

 

The EEG - during EEG - monitoring of regional night's sleep revealed epileptiforming activity (frequent, single and serial spikes of slowing activity) from anterior temporal zone dealing with periodic spread in the right central area. Epileptiforming activity is recorded in all stages of sleep. Physiological patterns expressed satisfactorily (preferably in the left hemisphere). Cycling EEG - sleep phases are not violated.

 

On MRI of the brain (06. 07. 2015) - in the right frontal part is determined liquor cavity of irregular shape with clear contours with size 9.2 * 5.2 * 6.5 cm, which connects to the front corner of the right lateral ventricle. Posterior parts of right lateral ventricle are dilated to 1.9 cm. Throughout other departments of  the ventricular system are not changed. Moderately extended cavity of Vergae. Backwards from liquor cavity brain substance of superior temporal region and posterior frontal region are reduced in volume, MR - signal from it is patchy, hyperintensive on T2VI, hypointensive on T1VI in its projections appear multiple areas of encefalomalation. Similar changes in the area of ​​length to 2.3 cm are observed in parts of the medial cingulate gyrus. Corpus callosum is evident only in the posterior part. Optic chiasma, pituitary gland, pons departments, cerebellum without focal changes. Formations of the middle line is not shifted.

 

Conclusion - MR - signs of destructive changes in the brain due to suffering from intracerebral hemorrhage. Condition after drainage of liquor cyst.

 

Baranik Karina

The wishes of parents - quality diagnostics, consultations of neurologist and neurosurgeon

case № 0011
Diagnosis:

Diabetes mellitus, I st type. Diabetic nephropathy. Dysfunction of the gallbladder, pancreatic type. Chronic pancreatitis. Chronic cholecystitis. Gastroduodenitis.

Case description:

Date of birth - 18.02.1990 


In 2012 in patient was diagnosed pancreatitis and cholecystitis. The disease was treated in hospital - were given diet advices and medicamentations which accelerate discharge of bile. In 2014 became pregnant. The pain intensified, but the medications during pregnancy were not intended, because of the harm to the fetus. During pregnancy was diagnosed - preeclampsia, the patient had expressed swelling, pain in the gallbladder and pancreas, which irradiated to the back. The patient passed blood tests for glucose level - glucose during pregnancy was normal. 13.05.2015 by cesarean section, the baby was born with weight 6300 grams. In delivery house the patient passed blood tests for glucose level - indexes were normal. After birth, the patient felt not good - maintained pain in the gallbladder and pancreas, decreased acuteness of vision. Also observed inflammatory reaction of axillary lymph nodes. The patient appealed to the hospital - but doctors could not explain her health worsening. 4 months after delivery the condition of the patient was not satisfactory - at that time patient passed analysis for glycated hemoglobin - the result was 9.7% (norm - up to 6.2%). Stationary to the patient was scheduled insulin - Novorapid (short-acting insulin) 4-6 Units and Lantus (insulin long-acting) 10-12 Units. On the background of this treatment and detoxification i /v therapy patient's condition improved - improved vision, lymph nodes decreased in size. In the hospital patient passed ultrasound examination of abdomen- gallbladder has S- shape.
Currently the patient complains on pain in the pancreas and gallbladder, which irradiates to the back, bitter taste in the mouth, digestive disorders, a significant increase in blood glucose in the absence hypoglycemia in the night. Last patient was treated from 11.10.2015 to 21.10.2015.


Concomitant diseases - pyelonephritis, tonsillitis.


Currently takes drugs - Novorapid (short-acting insulin) Lantus (insulin prolonged action), allohol (choleretic, dry bile) Pancreatin 8000, fish fat.

Patient - Victoria Leonhardt
Wishes of the patient - treatment in the country with a minimum of visa documents for travel in the fastest time, with the availability of qualified professionals who are able to conduct a full examination, to establish correct diagnosis and proper treatment. Consider a few variants.

case № 0010
Diagnosis:

The progressive kyphosis of thoracic part of spine. Sherman - Mau disease. Deformation of trunk. Pain syndrome.

Concomitant diseases - pulmonary stenosis I st. (15 mm Hg)

Case description:

 

Date of birth -20.01.2002

 

The disease started to progress two years ago. Now there is an exacerbation of pain syndrome.

 

 

 

 

Voznyuk Veronica 

The wish of parents - providing of surgical treatment.

case № 0009
Diagnosis:

MPMT (multiple primary malignant tumors). Peripheral cancer of the lower lobe of left lung cT1bN0M0. Condition after lobectomy in 2012. Prostate cancer T3bN1M0.Condition after surgery in August 2013.The progression of disease with metastases in the upper lobe of the left lung. Condition after marginal resection in 19.08.2015. Relapse in remaining lobe? Granulation tissue?

 

Concomitant diseases: Hypertensive disease II st., Ischemic heart disease, atherosclerotic cardiosclerosis. Diabetes mellitus type II. Chronic obstructive lung disease of moderate severity, emphysematous type.Cyst of the right kidney.

Case description:

Patient is 74 years old.

Date of birth - 05.02.1941

Blood group - A (II) Rh (+)

In 2012, in the patient was diagnosed - peripheral tumor of the lower lobe of the left lung.

04.07.2012 to the patient was provided operation – thoracotomy from the left side, the radical lower lobectomy, lymph node dissection, drainage of pleural cavity. The Type R 0.

Histological examination of the operational material -  in the lower lobe of the left lung - moderately differentiated squamous cell carcinoma with necrotic areas 2.5 cm in diameter. Bronchopulmonary lymph nodes and lymph nodes groups 6,7,8,11 – without  metastases. Separately marked area in the lower lobe - fibrosis. Edge of  resection - without tumor.

The postoperative period was without complications.

For several  years patient was under the supervision of an urologist because of the increase in PSA levels. During the biopsy (05.08.2013) - diagnosed cancer of the prostate.

19.11.2013 to the patient was provided operation - a radical prostatectomy with saving of nervous innervation.

Histological examination of the surgical material – small acinar prostate adenocarcinoma, Gleason score - 3 + 4 = 7, 30% of the lesions, mainly on the periphery from the left side with perivascular proliferation on the background of glandular - stromal hyperplasia with multiple foci of PIN - 2, chronic prostatitis with pronounced inflammatory component.

19.08.2015 to the patient was provided operation –rethoracotomy from the left side. Marginal resection of the left upper lobe with resection of the adventition of the aorta.

The next examinations of lung tissue show different results:

Pathomorphological examination(04.09.2015) - peripheral adenocarcinoma G3 (tumor cells CK7, TTF1,CK18 - positive, CK5/6,synaptofizyn,chromohranin, PSA, PSMA - negative, p63 - weak focal positive) of upper lobe of left lung, 3,5 cm in widest dimension. Margin of the resection - beyond the tumor. Primary operating material for comparative analysis is not delivered.

Pathomorphological examination (18.09.2015) - low differentiated squamous keratinized lung cancer. 9 lymph nodes - without metastases.

Cytology (16.10.2015)blood,fibroblastic and histiocytic - macrophage cells. Tumor cells are not found.

Pathomorphological examination (29.10.2015) - small areas of lung parenchyma with focal fibrosis. Morphological studies of previously removed lung tumor tissue are not delivered.

Patient - Chmelevsky Vladymyr.

The patient needs a qualified diagnostics and the final establishment of the correct diagnosis.

case № 0008
Diagnosis:

Vascular abnormalities of the kidneys - a doubling of the renal artery, compression of both ureters. Condition after complications of pregnancy and childbirth. Bilateral ureterohydronephrosis III degree. Bladder - renal pelvis reflux. Extravasal compression of right ureter by  additional inferior right renal artery. Extravasal compression of the left ureter additional inferior left renal artery. Compression of the left ureter by enlarged venous plexus of kidneys gate and varikoovariuum. Strictures of upper part of both ureters. Urethral stricture. Chronic renal failure I degree. Secondary chronic recurrent bacterial cystitis, pyelonephritis. Aorto-mesenteric compression of the left renal vein. Secondary varikoovarium from the left side. The syndrome of pelvic venous plethora. Hypertension (periodically with fluid retention, urine). Splanchnoptosis.Nephroptosis, cystocele. Retroflexio of uterus ( before pregnancy was anteflexio).

Case description:

Date of birth - 21.04.1986

Complaints on pain in the lumbar region on both sides, especially on the left, pain in the ureters (particularly during urination), and not just urinating, forced standing tilted forward, difficulty, faltering, sometimes splashing urine when urinating, forced supine position for filling of the bladder and to reduce pelvic  venous plethora. Condition after complications of pregnancy and childbirth (19.10.2011).

On 32 weeks of pregnancy patient noticed a decrease of diuresis, about 500-700 ml of urine per day, and with the growth of the fetus condition became worse, later developed hydronephrosis and pyelonephritis. On  34 weeks of gestation was hospitalized to hospital with a diagnosis pregestosis (slightly delayed liquid and visible swelling was not yet). The patient was conducted to intensive resuscitation unit and to her was provided intensive  infusion therapy. Weight before the intensive care unit was 61 kg, and after 3 days became 69 kg. Urine was almost red,  in the urine was high protein, red blood cells, white blood cells. Delivery was  stimulated at 37 weeks of gestation, during  childbirth began moderate  preeclampsy. There was also the trauma of the urethra, bladder when the catheter of Foley  was wrong  removed after delivery  about a week was bleeding from the urethra. The urine in the bladder is not fixed as it used to prior to pregnancy, there is a bilateral reflux. After delivery, began to disappear all the liquid, resulting in fallen of organs : two kidneys, bladder, and other organs. The uterus changed position from anteflexio to retroflexio.

After delivery, when the patient is in standing position, the urine moves in small portions with the strong arching of back pain, feeling of heaviness in the pelvis. Before pregnancy these complains were absent. And when patient is in horizontal position, the urine sample is much more in volume and for urine it's easier to reach the bladder, passes a feeling of heaviness in the pelvis. 2-3 hours of  lying may deviate from 500 -850 ml of urine and urine sample is larger, compared to being in an upright position. Now often develop permanent chronic cystitis and pyelonephritis from January 2015, as soon as the urine is delayed, because of what is patient often takes antibiotics, and there is resistance to the drugs. Before pregnancy concerning  urology and nephrology were no complaints.

During the cystoscopy was found deformation of the bladder; difficulty urinating, intermittent (reflux is present), cystocele. Before pregnancy blood pressure was 120/80 mm Hg, and after is 90/60 mmHg. Periodically, there are rises in blood pressure on the background of fluid retention, and violations of the outflow of urine output.

31.08. 2014 was performed surgery to stenting of the left renal vein. But retrograde flow on the left ovarian vein is still preserved and compressed the left ureter.

Concomitant diseases - Chronic duodenitis. Respiratory Syndrome (a cardiac etiology). Echocardioscopy from 04.12.2015: Minimum PMK with regurgitation at the level of the valves. Partly tricuspid insufficiency. Blood flow in the abdominal aorta is pulsating. Myopia -3,5-4 diopters.

 

 

Matvienkova Ekaterina

 

The wishes of the patient -  consultation of the urologist, vascular surgeon + the operation to save renal function.

case № 0007
Diagnosis:

Cr of ascending colon IV st. (locally disseminated). Acute intestinal obstruction.

Case description:

Patient was admitted to the hospital with signs of intestinal obstruction. When colonoscopy was provided – was found constrictive Cr.

Conservative treatment was ineffective.

17.12.2015 was operation was provided - laparotomy, was formated ileotransversoanastomosis. During revision - liver metastases were NOT found. Tumor is large, sprouting all walls of intestine, invades the retroperitoneal space, motionless. The large metastases in the mesentery roots of the small intestine. Patohistology – 25.12.2015, the small pieces of intestine with the growth of mucusproducing adenocarcinoma (G3), intestinal type with ulceration and necrosis.

Сountry in which the patient wants to be treated - Israel.

case № 0006
Diagnosis:

Cr of the left breast pT2pN2M1, clinical group II, st. IV, liver MTS.  Condition after left-side mastectomy, hysterectomy with appendages, left hemihepatectomy of the left lobe of liver and thermal ablation of the right lobe of liver, removal of gallbladder.

Case description:

Date of birth - 01.09.1970

Main points:

10.09.2007  - diagnosed infiltrative ductal carcinoma with a predominance of intraductal component 

Operations: 04.09.2007 -  mastectomy of the left breast

24.12.2007 -  supravaginal amputation of uterus with appendages

04.09.2012 year - resection of the left lateral section of the liver, removal of the gallbladder

12.09.2013 - Radiofrequency thermoablation of liver

07.08.2015 year - Radiofrequency thermoablation of liver

Chemotherapy - 12 courses, the last - in December 2012

Radiation therapy - not performed.

In 2007 to the patient was diagnosed cancer of the left breast ER (-) PR (+) HER -2n (+). 04.09.2007 was provided operation - sectoral resection of the left breast. The operation expanded to radical subcutaneous mastectomy of the left breast by Madden. Was diagnosed infiltrative ductal carcinoma with a predominance of intraductal component. In 2 of 4 th lymph node were detected massive metastases . Immunohistochemical examination - 80% of malignant cells express progesterone receptors, estrogen receptor expression in the studied tumors cells is absent. Expression of Her2 / neu is determined in 50% of the tumor cells (1+). The test material does not express glutathione - S- transferase and P - glycoprotein, which indicates the sensitivity of tumors to the drug cisplatin, and a number of anthracycline antibiotics. The proliferative potential of the tumor is low (30-40% of Ki-67 positive cells). There was started chemotherapy: doxorubicin 100 mg and cyclophosphamide 1.2 (3 blocks).
24.12.2007 was provided operation. Histological examination: The endometrium is proliferative. Bilateral follicular cysts. Postoperatively, the patient received 6 cycles of chemotherapy (2 of them - paclitaxel). From 2008 to 2012 woman received tamoxifen 20 mg / per day.
In 2012, during the ultrasound examination, in the left lobe of the liver was diagnosed formation 20 mm in diameter, low echogenicity. Tamoxifen has been canceled. 04.09.2012 was provided operation - resection of the left lateral section of the liver. During revision of Sg3 of liver was palpated tight - elastic neoplasm up to 7 cm in diameter. Histopathological examination: poorly differentiated adenocarcinoma with infiltrative anaplasia , multiple sclerosis. Patohistochimical research: morphological changes and immunophenotype of metastases of breast - carcinoma with loss of receptors TR / PR.
During 2012 woman received chemotherapy (carboplatin , taxoter). Ambulatory received Faslodex - 500 mg 1 time per month. During ultrasound examination of liver in 4-5 segments was visualized tumor, with reduced echogenicity, heterogeneous structure with size 22 × 24 mm, with a clear irregular contour.
Continues to receive Faslodex. 09.12.2013 was provided operation: Radiofrequency thermoablation of metastatic breast cancer in  Sg 5 of liver. 03.12.2013 was repeated burning of place of thermoablation. During the histopathological examination - microscopic description - signs of liver carcinoma and psevdopapilar microalveolar structure. Tumor cells have an extensive eosinophilic cytoplasm in some cells there are signs of apocrinisation which is characteristic of the breast parenchyma.
The results of immunohistochemical study:
Estrogenreceptor (1D5) - negative reaction
Progesteronreceptor (636) - negative reaction
Cytokeratin 7 (OV-TL 12/30) - negative reaction
Cytokeratin 20 (k 20.8) - negative reaction
Cytokeratin 17 - negative reaction
Cytokeratin 19 - negative reaction.
Bone scan - a bone scan - signs of focal lesions of the skeleton were not found.
09.06.2014 - molecular - cytogenetic analysis - identified gene amplification HER-2 / neu.   ER + (5), PR + (5), HER- neu2 + (status uncertain). Conclusion: Determined gene amplification HER - 2 / neu.
Prolonged administration of Fazlodex 500 mg.
06.07.2015 on MRI in the projection of the 6 segment  of the liver was found the round formation with high MR - signal with size about 1.27 cm.
07.08.2015 was provided thermoablation on the affected area of 6 segment of liver.
07.09.2015 at the histopathological examination - liver tissue with irregularly expressed (moderate) protein degradation, small and large centers of high- drop fatty degeneration, focal necrosis, small foci of inflammatory infiltration in the parenchyma - fibrosis in the portal tracts. The nature of the changes suggests herpetic character.
Revealed positive DNA of TTV (TT hepatitis virus), PCR - identified CMV Ig G - 8.5 positive and herpes I type Ig G 21.2 - positive.
Recommended antiviral therapy, to continue taking Fazlodex.

Alla Tkachenko
The wishes of the patient - Consultation
- Direction of future treatment
- Life extension

case № 0005
Diagnosis:

Chondroid chordoma of middle cranial fossa with dissemination to posterior cranial fossa, extracranial. Condition after operation (22.09.2015) - resection of chordoma of middle cranial fossa from the left side.

Case description:

Patient is sick since 2011.
Before the operation, in September 2015, there were complaints on headache, exophthalmos from the left side.

22.09.15 - was provided operation -  resection of chordoma of middle cranial fossa from the left side.

Histological examination of operational material - chondroid chordoma.

The patient's condition before surgery was moderate severity. Heart sounds are resonant. Blood pressure - 135/70  Hg mm. HR - 84 beats/min. Vesicular breathing. BR - 18 / min. Abdominal palpation is painless. Stool and urine are not affected.

Consciousness is clear. Glasgow coma scale - 15 points. Verbal contact is available. The photoreaction is saved. The sensitivity and movement are saved. The function of pelvic organs are controled.

Laboratory Methods:

General blood count - RBC - 3.47 * 1012/ L, WBC - 12.8 * 109/ L, hemoglobin - 111 g / l.

Urinalysis: leucocytes 1-2 in the field of view.

Biochemical analysis of blood: total protein - 68 g / l, total bilirubin - 10.3 mkmol / l, urea - 4.8 mmol / l.

Deleted only part of the tumor. Radiation therapy patient did not receive. To the patient Ukrainian doctors recommend chemotherapy.
Distantly patient was consulted at Massachusetts General Hospital (Boston) - was recommended after re-operation to conduct proton therapy.

Matviiv Oleg

Patient needs:

- the final removal of the tumor

- conducting proton therapy

Please write what are the proposals for the treatment of this patient. To the offers attach resume of the doctor who will treat the patient and the estimated cost of the treatment.

P.S. If you can not open a file with MRI - you must download the program Radiant DICOM Viewer.

case № 0004
Diagnosis:

The сonsequences of endured neuroinfection - encephalitis (2008) as low flaccid paraparesis, psycho-organic syndrome, symptomatic epilepsy - generalized сloniс - tonic seizures. Hypermetropia of Ist degree in both eyes.

Case description:

The child is 7.5 years old.
      Complaints on the growth rate of seizures, the absence of speech, behavioral disorders, falling while walking. Seizures during the last 6 months - rarely. Antiepileptic therapy child does not get because of the side-effects in the form of ataxia, hypersomnia, vomiting.
      The child was born from the II pregnancy, which passed on the background of the threat of interruption at 7-8 weeks, ARVI in 20-21 weeks and 40 weeks of gestation. During childbirth - once tight entanglement of umbilical cord around the neck of the fetus. The child's condition worsened on the second day of life - in the form of respiratory failure, seizures. In the Intensive care unit was diagnosed congenital pneumonia, further additionally investigated liquor - without pathologic changes. The patient was discharged with improvement of health. In age of 2 months child was treated one more time because of bilateral pneumonia.
          At age 3 months for 1 month child was treated in the hospital with a diagnosis: Chronic flaccid non - identified encephalitis, presumably specific etiology, with the development of compensated hydrocephaly,paraparesis of lower extremities. During examination (PCR of cerebrospinal fluid) - DNA of cytomegalovirus, herpes simplex type I and II - have been not found.
        Neurological status at the moment: cerebro - brain innervation - symmetrical palpebral fissures, active photoreactions. Babbling speech.Locomotive and reflex activity: active movements are not restricted. The muscle tone has a tendency towards hypotonia. No verbal contact. Tendon reflexes and periosteal reflexes in the upper extremities D = S, active, in the lower extremities D = S, torpid. No sensitivity disorders. Pathological signs are absent. Tension symptoms negative.Vegetative nervous system: prompt white dermographism. The function of the pelvic organs is not broken, no skills of neatness.
Child is in need of constant help of a third part in the performance of self-service functions (eating, drinking, walking with assistance), completely dependent from the mother.

Soltys Vladymyr


Parents wish: - consultation of neurologist, neurosurgeon (if necessary, other specialists)
- examination of the child
- determination if is needed medical treatment
- the main task - to improve the psycho - motor development of the child
Budget case.

case № 0003
Diagnosis:

Congenital defect of development of brain - agenesis of corpus callosum, internal occlusive hydrocephaly in stage of subcompensation, low spastic tetraparesis. Moderate mental retardation, underdevelopment of speech II st. Disorders of psychological development. Symptomatic epilepsy.

Case description:

Child is 11 years old. The child is from the first pregnancy on background of fetoplacental insufficiency with chronic hypoxia of fetus. On 41 week of gestation – delivery with stimulation. Baby"s weight at birth – 4350 g. Apgar score – 3/5 points. In newborn period – tonico- clonic convulsions (left hand, mimic muscles) and breathing disorders. From the 1-st day of life baby was treated in pathology of newborns in Ternopil regional hospital. On additional ventilation of lungs – 13 days. In age of 2 months baby was consulted in Institute of Neurosurgery in Kyiv. On the moment of objective examination baby didn"t need neurosurgery treatment ( conclusion of neurosurgeon – subcompensated hydrocephaly after intracranial haemorrhage on background of severe perinatal encephalopathy of hypoxic – ischemic character). Up to 6 months there was intensive enlargement of liquor ways (D – 55 mm, S – 60 mm, III – 10 mm). Child started to turn from side to side in 10 months, started to crawl, to sit by himself from 1 year 2 months,to walk by himself in 1 year 11 months, first words from 1 year 5 months. Treatment: dehydratation medicaments (diakarb +asparcam, glycerin mixture) vascular therapy (actovegin, cynnarizin, tanacan), cerebroprotectors and nootropes, homotoxycological preparates " Heel", vitaminotherapy, craniosacral therapy. In 7 years age tonico – clonic convulsions recovered (1-2 times a month). Anticonvulsive drugs baby took up to 2 months (Depakin), later – parents refused. In 2014 convulsions were 1 time in 2-3 months with duration from 60 seconds to 3 minutes, finished by themselves without treatment, had tonico – clonic character, sometimes without loss of consciousness. On this moment remission – 10 months. Neurological status : general condition is disturbed . On examination child reacts negatively. On questions child doesn’t answer, but there are signs of interest and facial motor actions. Size of head 55 cm, hydrocephal shape of head. Cranial brain innervation. Nonaccomodation convergent squint from the left side, hypersalivation is non – stable (during emotions and inflectional diseases it increases). Walk is spastic – paretic. Muscle tonus is distonic with hypotonia of trunk and hypertonus in distal parts of lower extremities, more expressed from the left. Ostal and periostal reflexes are higher from hands D>S, expressive, fast disappear from lower extremities S>D. Spontaneous Babinsky reflex which appeares from both sides. Coordinative probes child doesn’t provide. Communication is not good developed. In night time social skills are present, in day time – not always present. Simple commands child understand, can perform, says some words, plays, disinhibited, attention is quickly exhausted, emotions are unstable, meteosensitive.

Popovych Vladyslav

Parents wish: - consultation of neurologist, neurosurgeon, speech therapist (if necessary, other specialists)

- Examination of the child

- Determine if child need medical treatment

- Identify key moments of rehabilitation and restorative treatment of the child

- The main task - to improve the psycho - motor development of the child

Budget case.

case № 0002
Diagnosis:

Malignant tumour of basis of the skull (cranio - fascial hemangiopericytoma) with extra – intracranial dissemination (clinoid space, ethmoid bone, maxillary sinus)

Case description:

Patient is sick since 2008, when appeared complaints of headaches and fits of unmotivated irritation.There was diagnosed tumor of of basis of the skull. 02.07.08 patient had an operation - partial removal of extracerebral tumor of anterior cranial fossa from the right side.During the operation developed massive parenchymal bleeding from tumor vessels. Because of severe bleeding and hemodynamic infringement operation was stopped. After stabilization of condition was performed second operation 22.07.08 - total removal of extracerebral tumor of anterior cranial fossa from the right side. On histological examination was observed anaplastic hemangiopericytal meningioma with extensive areas of necrosis. Subsequently, MRI found that tumor growth is continuing. 06.04.2011 because of this, next operation was done. 12.12.2014 to patient was performed one more operation - subtotal removal of extracerebral tumor of anterior cranial fossa from the right side. Radiological therapy was used in 2011 - without the desired effect.

case № 0001
Diagnosis:

Epileptic encephalopathy with frequent therapeutically resistant polymorphic epi-attacks (partial myoclonic, tonico -clonic seizures, partial tonic seizures - syndrome of Lennox - Gastaut ) in a child with a congenital abnormality of the brain - the corpus callosum hypoplasia. Spastic tetraparesis more expressed from the right side with moderately stable dysfunction, retardation of psycho-lingual development.

Case description:

Child is from 3rd pregnancy, 3rd immediate delivery, which proceeded without complications. The weight of the baby at birth - 3500 g. At 4 - day of life in the child began neonatal seizures. Consulted in OHMATDET (in Kyiv). From medications takes sabril, clonazepam. Neurological status: productive contact is absent, microcephal shape of the skull with flattened asymmetric occiput, horizontal nystagmus, muscle tone diffusely decreased with relative hypertonus in extensors of feet, high knee reflexes with the expansion of reflexogenic zone,klonus of the feet, Babinsky s-m on both sides. Baby doesn"t stand and sit by herself.