Neurology

Is the sedation used for MRI safe for children?

What is the cause of severe pain in the neck and whirling sensation?

What is the cause of seizures when the brain is normal?

 

Is the sedation used for MRI safe for children?

 

Q. My son is 16 months old. The doctors say that he shows some autistic traits. For this, he is going to have a brain scan using MRI and he will be sedated. Are there any risks involved in this? What will the brain scan effectively show?

A. Usually the sedation used for MRI scan is safe and the scan is being done to find out if the autistic behaviour is associated with any underlying lesion in the brain.


What is the cause of severe pain in the neck and whirling sensation?

Q. My wife is suffering from pain at the back of the neck on the right side. The pain starts behind the right ear and continues up to the back of the neck's right side. At times she has a whirling sensation and complaints that everything around her is revolving. Her right ear has a sensation of fullness, which irritates her. Couple of months ago, this was also associated with severe headache and occasional vomiting. She is very depressed with all these problems. Our family physician diagnosed it as vertigo and prescribed Vertin 16mg three times a day during severe conditions. He also suggested Betacap 40 TR, Tryptomer 25mg one each a day for a month. The headache stopped after this. Then the doctor asked her to reduce the dose of Vertin gradually to 8 mg a day for over 2-3 months. He also suggested stopping it if there is no problem. She stopped for a month because she had none of the above problems. After stopping, similar symptoms appeared again, but without the headache. The doctor prescribed Vertin again, but there was no relief. She consulted an ENT specialist, who suspected frontal sinusitis & took a CT scan. Although the CT scan report shows normal, the doctor suggests a surgery to rectify the frontal sinusitis. We consulted another ENT specialist, who referred us to a neurologist. The neurologist attributed all the symptoms to a kind of migraine, suggesting the following medicines for a month - Zapiz (Clonazepam) 0.25 mg during nights, Trilol SR-40 (Propranolol HCL) 1/2 each in the morning & night, Libotryp (chlordiazepoxide & amitriptyline hydrochloride) 1 during nights. It has been a week since she has been taking these tablets, and we are waiting for the effect of these. Now we are confused whether to go to a physician, ENT specialist or a neurologist. Please suggest a suitable medical treatment for the above problem.

A. Vertigo (which is commonly described as spinning, rotating or dizzy sensations) can have many causes and migraine is certainly one of them. However, when associated with migraine, it is closely related with headache. Your symptoms of severe headache and vomiting (especially if pulsatile) raise the possibility of migraine and the close temporal association of vertigo with it can be explained by migraine itself. In that case your wife is likely to benefit from preventive treatment of migraine, which has been advised.


However, as I have mentioned earlier, vertigo can be due to other causes as well and therefore these need to be excluded. This is particularly true if the vertigo is present with new onset headache (that is, the headache which your wife experienced started only recently and previously there was no history of headache) and more so when vertigo is occurring without headache (as is the picture now).

Frontal sinusitis is unlikely to cause vertigo. It can cause headache but that is usually frontal and not at the back of head. Evidence of sinusitis can be found on CT in many normal persons and only becomes significant when it can be correlated with clinical symptoms.

Vertin is an anti vertigo agent with specific indications and not to be used indiscriminately.

I think you should consult a good neurologist.

 

What is the cause of seizures when the brain is normal?

Q. What are focal seizures? My son is 4 years old and he is autistic. He had seizures once and after a month he had seizures again. His MRI is absolutely normal with no complications. Hence the cause of seizures could not be detected. He has been put on anti-convulsant drug (tegrital syrup) for about 2 years. If we stop the drug, will the seizures stop forever? What could be the cause of seizures as MRI is normal? Can forceps delivery be the cause of autism?

A. Focal seizures mean that convulsions or fits do not involve the whole body but only a part of it e.g. one arm or one leg or facial twitchings, etc. Usually they are not associated with loss of consciousness. MRI only tells us that the brain is normal structurally. EEG may be able to tell us whether there is any abnormal discharge from the brain responsible for convulsions. If the child is seizure free for 2-3 years, is neurologically normal and EEG is normal then gradually anticonvulsants can be taken off and most of the children will not have recurrence of seizures. Meningitis at 2 months could be the cause of seizures and abnormal neurological behaviour. I don't think forceps delivery can cause autism.