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Dr. Frank
Dr. Frank, Board Certified Physician
Category: Neurology
Satisfied Customers: 7202
Experience:  Board certified general Adult Neurologist, with experience in experimental neuroimaging and neurodiagnostics.
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My 3 y.o. son came home from the first long visit with his

Customer Question

My 3 y.o. son came home from the first long visit with his dad (8 hours) 3 days ago. As soon as I saw him I noticed he was doing a forced blinking of his eyes repeatedly for 15 min periods of time and it continued all night. I thought he was tired but he continued doing it in the morning and next day. Then he was biking with his helmut on and fell later the next day. I saw the fall, he scraped his nose and had dirt on his mouth but did not seem to hit his head but immediately after he began doing a tick thing with his chin to his right shoulder and kicking his right leg up. Shortly after the fall he began sticking his tongue out and rolling it. The next morning, he was slurring his words and seems confused. His memory was off and he was DISTANT from me emotionally. He was staring into space at times and focused on activities for 15 mins at a time when usually he would do this for only 2-3 mins before. He seemed cognitively impaired. I took him to childrens hospital and they said they couldn't call neurology for whatever reason but said treat it like a concussion and gave us a referral to a pediatrician on thursday. they said his exam was "normal" and that they didn't see seizures present this way (because a video i showed him of him doing the tongue movement he was also moving a car with his other hand). I just spoke with a neurologist today at work and he said HIGHLY unlikely it is a concussion in a 2 year old and does not believe he has a brain bleed thus requiring a CT head scan. My son is marginally better today with his words but still has no balance, is wobbliy and little muscle tone. He is still somewhat confused and blinking. It's terrifying. The neurologist today said he needs an MRI and a referral to a pediatric neurologist. It's not that easy to get someone to give us that and even if they do, it's probably a year wait list here where I live. My son has had 2 surgeries for a midline nasal dermoid this past year (last one 2 months ago) with no obvious signs of infection however it had to be operated on again becasue the stitches didn't dissolve and there was an infection and cysts growing in there. The neuro today said it could be an infection or even stress. My son is not the same, please help. What's going on? Will he recover? Any suggestions as to what step to take next? I still cant believe childrens hospital wouldn't give us a neuro referral yesterday. Please help.
Submitted: 1 year ago.
Category: Neurology
Expert:  Dr. Frank replied 1 year ago.

neuromd2012 :

Hello

neuromd2012 :

welcome to Just Answer

Customer:

hello

Customer:

what do you think?

neuromd2012 :

HI

neuromd2012 :

well first

neuromd2012 :

what about this nasal dermoid?

Customer:

what abuot it?

neuromd2012 :

was there an intracranial extension?

Customer:

no

Customer:

thank god

neuromd2012 :

and that was imaged with MRI?

neuromd2012 :

correct?

Customer:

and ct yes

neuromd2012 :

good

Customer:

both said no intracranial extension

neuromd2012 :

so that also excludes temporal lobe anomalies

Customer:

i don't know

neuromd2012 :

and did he ever get an eeg?

Customer:

no

neuromd2012 :

ok

Customer:

i asked for it yesterday in the ER and they said NO

Customer:

i was shocked

Customer:

do i need one?

neuromd2012 :

I have a 3 year old, can you wait one min?

Customer:

sure

neuromd2012 :

i will be right back

Customer:

what are temporal lobe anomolies?

neuromd2012 :

ok

neuromd2012 :

hi

neuromd2012 :

so temporal lobe anomalies

neuromd2012 :

would be congenital changes in the temporal lobe of the brain

Customer:

no one said anything about this to us

neuromd2012 :

he had a full MRI of his brain so they would have looked at everything

neuromd2012 :

right

neuromd2012 :

I am just thinking of possibilities

Customer:

yes they did, so can i assume this would have been ruled out?

neuromd2012 :

yes

Customer:

ok

Customer:

so what do you think is going on? i'm terrified, he is not himself

Customer:

it's like he is another kid

Customer:

and he has emotionally distanced himself from me...we are like glue the two of us now he is pushing me away

Customer:

its weird

neuromd2012 :

well is he going through some new stress situation

Customer:

yes, being with his dad for 8 hours, it started right when he came home from being with him

Customer:

but why would he be this way with me?

neuromd2012 :

hard to say why, but kids can react

Customer:

with confusion, tics, memory loss, loss of balance, change in personality, head and tongue tick?????

neuromd2012 :

the question I had was is there any change in level of conciousness

Customer:

he has been more sleepy yes

Customer:

very sleepy

Customer:

since he came home from his dads

Customer:

that night he slept very early

Customer:

i was suprised and noted it expecting him to be up late

neuromd2012 :

so what happened in the er?

neuromd2012 :

did they do any blood work?

neuromd2012 :

has he spiked a temp

Customer:

they said his exam was normal whatever that means...and said they cant do a neurology referral because they are short staffed (like what?) and he had to see a pediatrician first and he/she would make the neuro referral if warranted. he sees this ped on thurs but he also sees his surgeon tomoror and i'm going to beg that he make the neuro referral as it is his hospital

neuromd2012 :

does he need a tox screen?

Customer:

no blood work

Customer:

tox screen for what?

Customer:

no temperature

neuromd2012 :

I don't know, what happened at his dad?

Customer:

he said the visit went fine no incident

Customer:

i have no idea

Customer:

so do i need blood work, a tox screen?

Customer:

an eeg?

neuromd2012 :

no just a urine

Customer:

mri?

Customer:

what do i do?

Customer:

who does that?

neuromd2012 :

I would get the eeG

neuromd2012 :

neurology peds

Customer:

i can't get to see them don't even have a referral yet

Customer:

it will take many months

neuromd2012 :

if his exam is normal, he really can't have anything new on the MRI

Customer:

they wouldn't consult neuro based on what they saw of him in the ER

Customer:

but what exam? all they did was walk with him

Customer:

it was a joke

neuromd2012 :

well they have to look in his eyes,

neuromd2012 :

check his eye movements

Customer:

they tried but my son wouldn't cooperate

neuromd2012 :

I see

Customer:

when they checked his eyes he didn't' follow much of the object he had to be prompted to follow it it was like he didn't even see it, the doc told me this is NORMAL for a 2 year old

Customer:

do you think so?

neuromd2012 :

he is 2 or 3

Customer:

why a tox screen? to see if he injested something?

neuromd2012 :

he should track

neuromd2012 :

yes

neuromd2012 :

I have no idea online

neuromd2012 :

but change in mental status

Customer:

he will be 3 in 2 months

neuromd2012 :

and some question

neuromd2012 :

you routinely check his urine

Customer:

why would i routinely check his urine?

Customer:

oh sorry i misunderstood

neuromd2012 :

no you dont check it

neuromd2012 :

the er checks it

neuromd2012 :

if there is some suspicion of change in behavior

Customer:

but they wouldn't do any testing

Customer:

it was weird

Customer:

should i go to the family doc and get him to send us to the ER requesting the tests?

neuromd2012 :

you need to take him to a doctor that knows him

Customer:

a parent cant go into the er and say i want urine screen blood work and an eeg lol

neuromd2012 :

whoever that is

neuromd2012 :

I know that

Customer:

they think i'm crazy

neuromd2012 :

but you just tell the doc that knows him from the past

Customer:

if i tell them what i want

Customer:

so you think, blood work, urine screen, eeg

Customer:

anything else?

neuromd2012 :

that there is an obvious change in his behavior, and tics

neuromd2012 :

and you want to know if this could be an absence attack

Customer:

what is that?

neuromd2012 :

that pretty much covers it

Customer:

an absence attack?

neuromd2012 :

that is a type of temporal lobe seizure

Customer:

coud this just be stress? have you seen anything like this?

neuromd2012 :

it has "automatisms"

neuromd2012 :

sure this could be stress, but you would expect him to revert back

Customer:

can you lose cognitive function from a seizure, like permanently

neuromd2012 :

tics especially in boys

neuromd2012 :

are mostly stress responses

Customer:

that is what i'm very afraid of, he is sooooo bright

neuromd2012 :

no you don't lose it permanently

neuromd2012 :

but if there is a change

neuromd2012 :

preceeded

neuromd2012 :

by a lip smacking

neuromd2012 :

for instance

neuromd2012 :

then that can be an absence attack

neuromd2012 :

the old term is petit mal seizure

neuromd2012 :

and it is very common

neuromd2012 :

it can start in this age group

Customer:

so can he lose iq from this?

neuromd2012 :

usually before age of 4

neuromd2012 :

no

Customer:

if it is a seizure how long does it take for him to come back? it's been 48 hours

neuromd2012 :

usually absence kids are very bright

neuromd2012 :

and most lose it in adolescence

Customer:

yes he is super bright

neuromd2012 :

about 2/3rd

neuromd2012 :

but with that brightness

neuromd2012 :

he can have tourettes

neuromd2012 :

or some tic disorder that is stress related

neuromd2012 :

but as this is the first time

neuromd2012 :

you have to cover all aspects

neuromd2012 :

so the ER was a good idea

neuromd2012 :

I am not sure why they did nothing

Customer:

who diagnose and treat tourettes and seizures?

neuromd2012 :

you only treat tourettes if it is reallly necessary

Customer:

i will go back in there tomorrow and just miss work if his surgeon doesn't advocate for us tomorrow?

neuromd2012 :

as the drugs are lousy

neuromd2012 :

ok

Customer:

a neurologist does this work? for tourettes and seizures?

neuromd2012 :

yes the surgeon that did the dermoid should have a clue here

neuromd2012 :

yes

neuromd2012 :

a pediatric neurologist

neuromd2012 :

does all that

neuromd2012 :

the eeg

neuromd2012 :

you should video tape him ok?

Customer:

it may take months to see one though

Customer:

if we are lucky that is

neuromd2012 :

and show the docs this behavior

Customer:

i have been video him

neuromd2012 :

good

Customer:

im so scared

Customer:

i want him back to normal

Customer:

can he change like this permanently?

Customer:

it's like he is not my child

Customer:

i don't know him

Customer:

he is vacant

Customer:

and distant

neuromd2012 :

we this is not a serious problem in the sense of danger to him

Customer:

he did ask repeated questions sometimes a few months ago...id ask a question and he's say "what" 4 times...i thought his hearing was off...he has also done these weird hand movements at times and swiped his arms across his face and made airplane sounds

neuromd2012 :

if he in not infected, his vitals are normal

Customer:

yes we need the blood work immediately

neuromd2012 :

any chance of a strept infection?

neuromd2012 :

in the past?

neuromd2012 :

you do need the blood work

Customer:

strept? what does that mean?

Customer:

he has been coughing and sneezing for a month now

neuromd2012 :

he could have syndenham's chores

neuromd2012 :

chorea

Customer:

i thougth it was mould in the house and am having the air quality tested (as there is aproblem of mould in the attick that is getting fixed)

neuromd2012 :

strept infection is a nasty sore throat

neuromd2012 :

he could have had it weeks before

Customer:

he hasn't cmoplained about his throat

Customer:

what is syndenhams chores?

neuromd2012 :

hang on

Customer:

ok

neuromd2012 :

I will get you a webpage hang on

neuromd2012 :

read this

neuromd2012 :

http://www.ninds.nih.gov/disorders/sydenham/sydenham.htm

Customer:

i will

neuromd2012 :

look at it now ok?

Customer:

so should i take him to the hospital tonight for this? or wait to speak to the surgeon tomororw morning

neuromd2012 :

look at the symptoms

neuromd2012 :

lets try to put our heads together

Customer:

can they test for syndenhams chores through blood work?

neuromd2012 :

yes

neuromd2012 :

they check a white count and an ASO titer

Customer:

ok so i have to go in a few mins

Customer:

can we summarize?

Customer:

you have been very helpful...

neuromd2012 :

there is also something called PANDAS

neuromd2012 :

hang on

neuromd2012 :

look at PANDAS

neuromd2012 :

it has the tics etc

neuromd2012 :

maybe he has PANDAS

neuromd2012 :

http://en.wikipedia.org/wiki/PANDAS

Customer:

ive always thought he has ocd, i have anxiety and he is very very particular about how things are to go

Customer:

just there

Customer:

does a blood test rule it out?

neuromd2012 :

yes

Customer:

so can i ask my gp to test for pandas and syndenhams chores?

neuromd2012 :

yes

neuromd2012 :

that sounds like a plan

neuromd2012 :

tell him about the tics, the emotional change

neuromd2012 :

and ask him about these two

neuromd2012 :

ok?

Customer:

how do you treat pandas?

Customer:

does it go away?

Customer:

or does the infections leave the child permanently like this?

neuromd2012 :

you treat it with antibiotics

Customer:

should i take him to the ER tonight for the blood work?

Customer:

or wait til tomorrow morning?

neuromd2012 :

this can wait until tommorrow morning

neuromd2012 :

if he has no fever

Customer:

he is on advil and tylenol all the time

neuromd2012 :

and no other problems like respiratory or cardiac symptoms

neuromd2012 :

I see ,

Customer:

he is coughing a lot

Customer:

and sneezing

neuromd2012 :

now

Customer:

off and on for a month

neuromd2012 :

oh

Customer:

the docs check his lungs and they aren't concerned

Customer:

mostly at night

neuromd2012 :

right

neuromd2012 :

so take him in tommorrow ok?

Customer:

ok

Customer:

anything else for me?

neuromd2012 :

no I think that is it

neuromd2012 :

get back to me anytime ok?

Customer:

how do i do that?

neuromd2012 :

Dr Frank T

neuromd2012 :

you just come back to this posting

neuromd2012 :

and write something

neuromd2012 :

and I will be notified

Customer:

ok i will thank you :)

neuromd2012 :

it might not be right away but I will be back

neuromd2012 :

ok?

neuromd2012 :

sure

Dr. Frank, Board Certified Physician
Category: Neurology
Satisfied Customers: 7202
Experience: Board certified general Adult Neurologist, with experience in experimental neuroimaging and neurodiagnostics.
Dr. Frank and other Neurology Specialists are ready to help you
Customer: replied 1 year ago.


what about regressive autism? only thing is, his speech is back to normal and his balance, he has continued with head nodding/tics, eye tics have stopped, had blood test, no infection found, throat swab in for pandas, eeg ordered, allergy testing panel ordered, hearing test ordered, and sent to have a full psychological assessment for autism. but if it was autism and a sudden loss of speech memory, tics, loss blaance etc...it wouldn't come back would it?

Expert:  Dr. Frank replied 1 year ago.
Hello. Autism isn't a bad choice, it can wax and wane depending on the outer environment, maybe the trip to his dad just set it off? I will paste in a webpage on different features of autism. One thing I might suggest is that if he gets an MRI, you request Tensor Diffusion Imaging, which is a new technique for looking at connections within the midline structures of the brain, and to the temporal lobes, which have been described as abnormal in children with autism. It is a better imaging test than PET, which requires a radiation dose, and speaks only to regional metabolism.

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Board certified general Adult Neurologist, with experience in experimental neuroimaging and neurodiagnostics.