Hello,
I am writing to seek your opinion in treatment of my mother who has been given Peg. Interferon and Ribavirin for Cirrocis caused by Hepatitis C. Now she has developed ceberal haemorrhage and has been in ICU for 10 days.
Below is brief history of the treatment. If you require more information, please do not hesitate to contact me. I can also arrange a teleconference with doctor who is treating the patient.
My mother now 55yrs was diagnosed of suffering with Cirroses about an year ago. On doctors recommendation, she was started on one injection/week of Peg Interferon (not sure of dose, will confirm & communicate). On third day (Feb 03) after third injection (Jan 30), patient had suffered seizure in the morning at about 4am, she was unconscious, had high fever and had trouble breathing. She was taken to the local clinic, where she was given oxygen support and was sent to hospital emergency. She was soon (in couple of hours) shifted to general ward with oxygen support. At that time, the patient was semi conscious and appeared to be getting better, however, the patient became very unconfortable on the night of 2nd day (Feb 04). On the afternoon of third day (Feb 05) in the hospital, patients respiratory system had almost collapsed and was taken to ICU. That day onwards, the patient remained in ICU, uncouncious but movement is observed in all body parts. Till this point doctors were suspecting Hepetic Coma.
On Feb 10, the CT scan was done, which revealed multiple foci of cerebral haemorrhage. The neurologist was involved, who suspected the Herpis Simplex Encephalitis and started treatment with Acyclovir and Mannitol. Till Feb 12, no improvement was seen and patient was also started on high dose of Methylpred. Today, Feb 14, no improvement has been seen in the sensorium, however no deterioration is seen either. Patient is moving all body parts ocassionally, however mental alertness is missing. Today another CT Scan was performed which indicated the status being same as noted in the scan taken 4days ago. Following are the results from CT Scan reports. Today the doctor showed doubts of ADM, however, medication has not been changed yet.
***CT Scan Feb 10 Report***
"Loss of grey white differentiation is noted in the biletral cerebral hemisphere with effacement of the superficial cortical sulci noted.
Multiple hyperdense foci (CT value 45-55 HU) are noted in the cortex and subcortical white matter of biletral cerebral hemisphere, predominently in the temporal lobes. Similarly hyperdense foci are also noted on the left side of corpus callosum.
Biletral lateral ventricals are mildly compressed.
Basel ganglia appear to be spared.
Basel Cisters are well defined.
No evidence of midline shift is noted.
Posterior cranial fossa shows normal brainstem, cerebellum and 4th ventrical.
Bone window shows no evidense of any fracture.
Post contrast study shows gyriform enhancement with no evidence of any focal lesious lessions noted.
IMPRESSION: Possibility of Herpy Simplex Encephalitis with haemorrhage may be considered in view of the predominently temporal distribution of involvement and sparing of the basel ganglia.
other Possibilities:
1. Adema
2. Sequelae to cerebral venous hypertension.
"
***CT Scan Feb 14 Report***
"Cerebral oedema is still noted in the biletral cerebral hemispheres with afffacement of the biletral superficial cortical sulci noted.
Biletral lateral ventricles are mildly compressed. (left>right)
The hyperdense foci mention in the previous report are still noted but appear to have reduced.
Rest of the findings are same as before.
Post contrast study shows gyriform enhancement but no evidence of any focal lesions noted.
IMPRESSION: No significant change as compared to the previous scan"
It seems the doctors are not able to diagnose the root cause. I shall be greatful if you could provide suggestions on treatment from your experience.
Thanking you in anticipation.
Sid.
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