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1-Year-Old Baby With Prolonged Convulsions Due To Rare Form Of Acute Leukoencephalopathy Restriction Diffusion (ALERD) Successfully Treated At Medicover Hospitals, Navi Mumbai



Navi Mumbai: Dr Narjohn Meshram, Head Of Paediatric ICU, Medicover Hospitals, Navi Mumbai, and the team gave a new lease of life to a year-old baby with prolonged repeated convulsions. This patient was having complaints like cough, cold, and fever for 2 days and loose stools owing to sepsis, Reyes like disease, severe dehydration, and prolonged seizures. The patient has been discharged from the hospital after successful treatment.


Parents of Arav Sinha (name changed)*a resident of Kharghar panicked after he had a cough, cold, fever for 2 days, and loose stools. They consulted a local doctor who gave him medication but his condition didn’t improve. However, his health started deteriorating and he was brought to Medicover Hospitals in an emergency on January 27 wherein he was given symptomatic treatments on an OPD basis.


Dr Narjohn Meshram, Head Of Paediatric ICU, Medicover Hospitals, Navi Mumbai said, “On arrival in an emergency he had severe breathlessness with impending respiratory failure, severe dehydration, and convulsions in the form of up rolling of the eyeball and tonic posturing. His blood gas was suggestive of too much acid in the body called metabolic acidosis and his heart rate on arrival was 230/min with poor peripheral pulses. The child was intubated in an emergency and started on severe dehydration correction and fluid boluses, and his pulses improved. He was given injections to manage continuous convulsions which subsided after some time.”


Dr Sandeep Sawant, HOD Paediatrics, Medicover Hospitals, Navi Mumbai added, “With prompt treatment, the child was extubated on day 3 of admission and put on humidified high-flow nasal cannula (HHHFNC) to improve his oxygen levels and breathing capacity. After extubating, the child was persistently drowsy despite sedation for more than 24 hrs and got intermittent convulsions again which subsided with injection, drip and he was reintubated. On February 2, the child started to have involuntary movements of the upper and lower limb. On performing a CT scan, it was normal but an abdominal ultrasound suggested fatty liver with a swollen and enlarged gall bladder. He was also suspected to have secondary mitochondrial Hepatopathy i.e. Reyes like disease). Gradually, he started to have lots of involuntary movements with poor sensorium. His EEG was suggestive of improvement in his condition. But the MRI revealed acute leukoencephalopathy with diffusion restriction which caused seizures which a rare in occurrence and difficult to treat.”


“On Day 7, the child was extubated again and put on HFNC, and started on medication to decrease involuntary movements. The child was unable to tolerate feeds. Later, the child was given antibiotics for persistent high-grade fever spikes and one episode of convulsion on February 5. His condition improved after a week and put on injection treatment and EEG monitoring,” said Dr Swapnil Patil, Associate Consultant in Paediatrics, Medicover Hospitals, Navi Mumbai.


Dr Meshram said, “The child started tolerating feeds, and the involuntary movements reduced. He does not have convulsions and is off oxygen. The child was stable and discharged after a month of hospital stay. On follow-up, the child was doing well. Not treating him at the right time would have led to death.”


“We were appalled to see our child suffering and in immense pain. We panicked after the fever didn’t subside and those continuous convulsions and seizures. He was known to have too many health problems which we weren’t even aware of. I thank the doctors from Medicover Hospitals for their prompt diagnosis and treatment. Our child is back at home and is achieving milestones for his age. Indeed, the doctors have saved the life of my child,” said Kushal Sinha (name changed)*, the father of the child.