Answers
1) Findings in CT Scan
- This is a Non contrast CT scan
- There is a large mass occupying third and lateral ventricle and extending to left temporal horn.
- The ventricles is dilated (Large hydrocephalus, possibly obstructive)
-VP Shunt catheter in situ but the tip of it seems to be obstructed by the tumor.
- Brain is edematous by evidence of loss of sulci-gyri differentiation.
- No midline shift
2) Diagnosis
a) Recurrent Pilocytic Astrocytoma with gross hydrocephalus secondary to non- functioning VP shunt.
b) Infection secondary to infected VP Shunt.
3) Management to this patient
a) Transfer patient to Neurology ward.
b) Blood investigation; RFT, GSH, LFT, PT/aPTT/INR.
c) Septic work out.
d) Urgent External Ventricular Drainage Insertion to relieve the hydrocephalus
e) Keep patient nil by mouth
f) Fluid therapy 60 cc ½NSD5% per hour (according to patient's body weight)
g) Monitor Input/ Output
h) Insert Continuous Catheter drainage
i) IV Rocephine stat 500 mg, then BD.
j) Load IV Phenytoin 15 mg/kg, followed by 1-2mg/kg tds (EBW is 30 kg)
k) Keep patient sedated and gives analgesic infusion.
l) Send CSF specimen from OT for histopathology examination and Culture and sensitivity.
m) To change antibiotic once the result of culture and sensitivity ready.
n) Strictly monitor patient condition.
o) To discuss further management of this patient with parents after emergency EVD.