Presentation of case suspected with Child Abuse

1. Dr. Amit Vatkar
MBBS, DCH, DNB Pediatrics
Fellow in Pediatric Neurology, Mumbai
Trained in Neurophysiology & Epilepsy, USA
Contact No. : +91-8767844488
Email: vatkaramit@yahoo.com

2. • 1 ½ yrs old female
• third child of non-consanguinous parents
• febrile seizures at the age of 1 yr in a private hospital.
• 1 ¼ yrs patient developed another episode of LEFT FOCAL
seizure
• CT Brain and prescribed
• Syp Valparin taken for 1 week

3. • Before 2 months - swelling in the left leg. Patient was taken to a
private practitioner. He gave some ointment and adviced X-ray.
• Next day morning - fracture of left tibia-medial 1/3rd and applied
BK slab and adviced change of BK slab weekly
• After 2 wks patient developed left focal seizures following fever-
high grade intermittent.
• The seizure lasted for about 10mins.
• The same evening patient developed another episode of left
focal seizures and was brought to GRH, treated as OP.

4. • father is a tea vendor whose monthly salary is
Rs.3000/- an alcoholic
• no parental disharmony.
• Mothers antenatal and natal history uneventful and
there is no developmental delay.

5. –Ophthalmologist found the retinal hemorrhages just superior
to the disc in the left eye and adviced review after 2 days.
–On review he diagnosed B/L retinal haemorrhage. On that day
patient developed recurrent vomitting and treated .
–In the CT-Brain left diffuse cerebral edema present.

6. • Condition at the time of admission
– Patient conscious
–Recognises mothers face
–Febrile
–Not anemic / Jaundiced
–No cyanosis / Clubbing
–No pedal edema
–No Neurocutaneous markers
 No external bruises
 No old injuries
 Left leg BK slab seen

7. RIGHT LEFT
Bulk UL N N
LL N N
Power UL >3/5 >3/5
LL >3/5 -
Tone UL N N
LL N -
• CNS
–Patient conscious, alert,
–PEARL
–EOM full
–AF not closed / not bulging
–No obvious cranial nerve palsies

8. Super ficial reflexes
Conjuctival
Corneal
Jaw jerk
Adbominal
+
+
+
+
+
+
+
+
DTR
Biceps
Triceps
Supinator
Knee
Ankle
+
+
+
+
+
+
+
+
Not able to
assess
Plantar  Not able to
assess

9. • Spine, Cranium Normal
• No cerebellar / meningeal signs
• CVS, RS – NAD
• P/Abdomen
– Soft
– Liver 2 cm  RCM
– BS+

13. • Now the patient has recovered well and there is no
further seizres. Right UL movements have improved
patient is on Syp Valparin
• Parental counselling and modification of life style
enforced.
• Condition at the time of discharge
–Patient conscious
–Recognises mothers face
–Afebrile
–PR 110 / min
– RR 26 / min
– BP 90 / 60 mmHg.

14. RIGHT LEFT
Power UL 3/5 >3/5
LL >3/5 >3/5
Tone UL N N
LL N N
Superficial reflexes + +
DTR + +
Plantar  
• CNS
–Patient conscious, alert,
–PEARL
–EOM full
–AF not closed / not bulging
–No obvious cranial nerve palsies

15. Dr. Amit Vatkar
Pediatric Neurologist, Navi Mumbai
MBBS, DNB
Email: vatkaramit@yahoo.com
Contact No.: +91-8767844488
Visit us at: http://pediatricneurology.in/
THANK YOU !