| Medical Information for Kenneth R. |
Kenneth was born from a II pregnancy and labour from a mother who is 18 years old (1st child was born on the 34/35th
week of pregnancy – died at the age of 1 month). The present labour was at the 35/35th week of pregnancy with a birth
weight of 2228 grams, Apgar 5/7. After birth the child was cyanotic, had edema. Breathing with clutching of the
assistant muscles. He was transported to the intensive care department of the Tallinn Children’s Hospital at the age of 1,
5 hours and from then on he was directed to the pathology department of infants in order to treat the respiratory dystrees
syndrome (RDS) and the anemia resulting from being a premature baby. He was allowed to go home at the age of 1
month and 4 days.
From then on the child was at the Tallinn Children’s Hospital on several occasions due to different important health
problems.
On 15.04.200-16.04.2001, at the age of 1 month and 24 days, he was hospitalized to do anemia that appeared with
hypothermia 35, 4, transfer of erytrocistary mass.
On 02.05.2001-08.06.2001, at the age of 2 months and 11 days, he was hospitalized due to consciousness disorder and
frequent convulsions. The liqvor was hemorragelic upon arrival. Subdural hematomas from the brain during the
computer-demographic examination. Detriment of the temporal-lobe on the right that is fitting with a previous brain
damage and there is suspicion of fresh blood in the left occipital lobe. The detriment would be appropriate for a traumatic
detriment. The mother and father denied abusing the child. The convulsions in dynamics do not appear again while
being treated with Timonil. EEG 09.05 epileptic activity in the central areas of the brain, thereby the treatment for
epilepsy was continued. During the first days of treatment his consciousness recovered, visual contact appeared, eye-
bottoms without pathology. The deepening intracranial hypertension is a problem. A repeated CT scan of the brain –
effects of a deepened brain atrophy. On 22.05 a shunt of the right ventricle-peritoneum (V.P.) was placed. The condition
of the child was stable, there have been no effects of intracranial hypertension. A constant eye-contact appeared and the
emotional development is appropriate for his age. Deepened effects of anemia again and thereby an ERM transfusion
50ml was done, after that the indicators of the red blood cells normalized. Upon leaving from the hospital the condition of
the child was satisfactory, good eye-contact, smiled, made sounds. Head girth 38cm. No pathology found in the inner
organs, slight overall spastics in the limbs. Weight 5332g, height 57 cm. Girth of the thorax 40, 0 cm.
On 03.07-15.07.2001 at the age of 4 months and 12 days - pneumonia acuta bilateralis.Enteritis acuta adenoviralis.
Otitis med. The parents have given up on raising the child. The child is living at the Haiba Orphanage.
On 03.09.2001 at the age of 6 months and 12 days, he was hospitalized with a suspicion of the malfunction of the V.P.
shunt. There was no treatment indicated for corrigating the shunt (Shunti korrigeerivat ravi ei oli näidustatud – ma ei
saa aru kas oli siis või ei olnud) and the treatment was continued with Timonil 30mg 3 times a day, overall massage,
Diakarb.
On 18.12.2001-25.10.2001 at the age of 8 months he had a surgery: the existing oclusated shunt-system was removed
and a new ventriculo-periteonal shunt-system was placed. Carbamasepin (Timonil) 30mg 3 times a day per os. The
given treatment resulted in the satisfactory condition of the patient. An application was compiled for the VEK for
appointing a disability.
On 28.10-06.11.01 at the age of 8 months bronchitis obstructiva, hernia ingvinalis dex. Treatment ampicillini
pulmicorti ventolini ambroxoli zyrtec sir.
On 12.11.-20.11.01 at the age of 8 months 21 days enteritis acuta. Bronchitis obstructiva. Otitis media acuta sin. Stayed
at the Tallinn Merimetsa Hospital.
On 04.12.-11.12.01 at the age of 9 months and 14 days. Epiglottitis ac.Bronchitis obstructiva.
On 11.12.01-17.01.2010 was hospitalized for examinations and developmental treatment. Does not rise to sit, he
achieves short-term balance when placed in the sitting position. Bioelectrical activity on the electroencephalogram as
appropriate for his age. No epileptic activity registered. Taking into account that the convulsions appeared during a
severe trauma-period, has not appeared later, it was decided to end the anticonvulsive treatment. Active, good-humored.
No important development was noted in the motorical development during the treatment period.
On 11.04.02 and 20.02.02 at the age of 1 year. Encephalopathy post traumatica. Diplegia spastica II. Infectio virusalis.
Hernia ing.bilateralis (operative treatment is planned). Developing of the motorical development: active verbal words
have appeared, is walking actively with support, tries to stand up without support, the spastics in his legs has decreased.
On 03.05-17.05.2002 at the age of 1 year and 2 months - Meningoencephalitis ac.Septitcaemia.
On 26.07.-01.08.02, on 07.10.-14.10.02., on 25.11.-02.12.02. Bronchitis acuta. On 28.01.2002 Pneumonia ac.
On 05.05.03 he was hospitalized to the surgical department for controlling the dynamics of the hydrocephalus.
Conclusion: the shunt is functioning on a satisfactory level. It is advised to continue with carbamazephin 100mg a day
for a period of at least one year as an anticonvulsive treatment, despite the fact that there have been no convulsions for a
long period of time. Growing and development has almost reached the norm that is appropriate for his age. There are no
direct limitations when it comes to care – a regime that is appropriate for his age.
Ever year from then on the child has been through a check-up at the Tallinn Clinical Children’s Hospital and starting
from 2005 at the Neurology and Neourorehabilitation department of the Children’s Clinic of the Tartu University Clinic
(27.03.05, 06.11.05, 09.06.09). 2005 MRT of the head + MR- porentcephal detriment of the both frontal lobes and the
right temporal lobe described based on the angiography. Probable V.Galen malformation and sinus transversus
hypoplasia on the left. It is a post-traumatic brain damage and anomaly of the brain blood-vessels.
On 09.06.09 at the age of 8 years he was hospitalized to the Tartu University Clinic for evaluating the dynamical
development. Height 127 cm, weight 28,9 kg. Otorinolaryngology examinations: thympannograms are in order on both
sides, toneaudiometria – normal hearing on both sides, otorhinoscopia – normal findings. Oftalmology examinations:
Visus od=0, 5+1.5cyl 99=0.5.Visus os=0.45+1.75 cyl 80=0.5. Has glasses. Refraction in the cycloplegy od +1.75 Dsph
+2.0 cyl 99. Refraction os +2.0 Dsph +2.0cyl 82. The front segment of the eye is in norm, free movement of the
bulbuses. Fundus ou – discs with clear borders, pale-pink. Macules, periferic find in norm as seen. Diagnose:
Astigmatismus ou..Atroo´phia n.optici?? Psychiatry: the boy is very moving, quite fidget and communicates without
choosing and keeping distance but he is friendly. Does not orient as appropriate for his age and does not know personal
data. Has a very concrete thinking. Non-verbal mental age is 4 years and 6 months according to Leiter. Has problems
with attention: is unable to keep his attention as needed and divide it among different stimuluses. His movements are
scrabbling and imprecise. His drawings are appropriate for children younger than he is. Vocabulary is satisfactory when
it comes to every-day use. He knows most of the letters and he successfully reads with some help. Has difficulties with
amounts, does not have enough attention, makes mistakes. The child needs to be teached on the basis of a simplified
curriculum. Speech-therapist: has constantly had a detriment of the higher language levels. Understanding speech is on
the level of a 5 year old according to Reynell. Is able to line up sounds to make words that consist of a few syllables. Upon
checking for learned skills he is fidget and unable to concentrate for a long period of time, he talks a lot. He makes babyish
comments. He needs a simplified curriculum that is appropriate for his mental abilities. Hemorgam with a five-part
leukogram is in order - WBC 6.98 RBC 5.03 HGB 140 g/l HCT 41 MCV 81.7 MCH 27.8 PLT 261 BASO% 0.6 MONO 11.2%
LYMPH 49.1% NEUT 35.8% EO 0.23%. Biochemistry - AST 22,ALT 14,LDH 453,CK 144 without pathology. Radiology.
Description: the T1,T2 and FLAIR images of the head are on different levels. MR-angiography of the intracranial arteries
as an additional examination. Compared to the last MRT on 29.03.2005 the results are not different when it comes to
intracranial findings. T-F bilaterally the liqorised areas of the previous detriment stay the same. The shape and size of
the liqor areas are without change, a shunt in the left side ventricle. The vascular structures and the scheme of the blood-
vessels are without change as well. Intracranial arteries are without crotchets upon the MR-angiogram.
Electroencephalogram: 1. EEG with a regular 8-9 Hz alpha activity when awake, slow waves on the left temporal at
times. No epileptiform signs appear. 2. sleep-signs while sleeping. Sharp waves on the right F area. No certain
epileptiform signs appear. Summary: Based on what is appropriate for his age there is focal slowing on the left, sharp
waves on the right. No certain epileptiform signs appear.
Diagnoses of the child:
Slight mental disorder with a severe behavioral disorder F70.1
Post-traumatic shuntsõltv hydrocephaly (sin) G91.3
Other malformation of the brain blood-vessels: probable vein Galen malformation Q28.3
Astigmatism; oc.utr. H52.2
Regime and recommendations: simplified curriculum at school is recommended
Immunizations:
BCG 30.03.01
Polio 10.10.03, 05.12.03,23.01.04,30.09.09
DT 10.10.03,05.12.03,30.09.09
MMR1 07.05.04
The child has been assigned with a severe disability until 12.10.2010
