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Dr. F
Dr. F, Board Certified MD
Category: Neurology
Satisfied Customers: 266
Experience:  Neurosurgeon with more than 20 years experience in practice and teaching.
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Diagnosing Hypotonia and brain abnormalities

Customer Question

My son was born with moderate hypotonia that has improved over time. He was born flat - Agpars of 3 and 7 with pulminary hypertension, and was unable to keep oxygen saturation up. He was released 21 days later when he could maintain his oxygen levels, and was admitted again 3 days later with viral meningitis caused by rotovirus which was recovered in about a week. They hypothesised his low tone when he was born would be transient and fade over time, but at his 10 week check up the paediatricia diagnosed hypotonic CP due to his still persistant low tone and poor head control (However he had no head lag present at 6 months). He has had 3 MRI scans down. The first at 6 days was considered a clear scan. The second at 10 weeks showed some loss of volume in the frontal lobes, more marked on the right than the left – but this loss of volume wasn’t considered anything significant but was the only notation that could be made of the MRI (The nuerologists said it wasn't ordinarily concerning except they could find no other explanation for the low tone persisting). They also noted that the ventricles had dilated from 5mm to 9mm between the 6 day and 10 week old scans. The 3rd done at 8 months, was done for an update on the condition of his brain to see if any of the hypothesised signs of stroke would be visible on his larger brain and to see if there was any evidence of hydrocephalus due to head circumference in 100th Percentile (However height is also at 97th Percentile)The scan has shown appropriate myelination and grey/white matter differentiation for age – and no damaged tissue, but still some overall reduction in brain volume – POSSIBLY more marked in the frontal lobe region of the brain. The Nuerologists that did the report believe the “volume loss” is controversial – given he has a head circumference above 100 percentile (the third scan was done for checking hydrocephalis of which there was none). They are unsure of whether there is an overall reduction in brain volume or there is just more room in his skull than normal – His MRI results still do not provide any indication of what is causing his low tone. A complete array has been completed, and metabolic and chromosomal defects have been ruled out. We are looking at either, Benign Congenital Hypotonia, or Hypotonic Cerebral Palsy. He spent 6 weeks in NICU when he was born for pulmonary hypertension. He appears to be around 6 weeks behind on all Milestones. He is 8 months and sitting independently, not crawling yet, supports his own weight, babbling m, b and g sounds (No da or di – and they hypothesise this is due to low tone in the front of the mouth). He responds to his name, shakes hands, plays peek-a-boo, and seems to be cognitively on track. He is fine with fine motor – his delays appear to be speech and gross motor – but he wouldn’t be further than 2 months behind, and rate of progression over time has been consistent with early intervention. Originally the diagnosis of Hypotonic CP was made at 2 months, because he had Hypotonia (Moderate), Nystagmus, Supposed Corical Visual Impairment, Ankle Clonus and infant reflexes. HOWEVER – He now has mild Hypotonia, no nystagmus, no clonus, and no persistent new born reflexes and his “CVI” turned out to be a visual delay and his vision is now ok so the only “symptom” of Hypotonic CP he is now left with is mild hypotonia. My question is do these 2 diagnosis fit his symptoms? What are the possible repurcussions of having slight reduced brain volume? What are the repurcussions of having a head that gives your brain too much room? What possible intellectual conditions could we be looking at? (As in would he be showing signs of mental retardation at this age if that was a possibility – or are we more then likely looking at higher cortical functioning conditions, like ADHD and executive functioning problems (memory, concentration, problem solving etc))

If he had an intrauterine stroke - wouldn't the damage of this be visible in the tissue of the brain by now if it were significant?

Submitted: 4 years ago.
Category: Neurology