Julie Lyles Carr: The Brain Doctor...

Thursday, September 18, 2008

The Brain Doctor...

Nothing like planning ahead.  It takes three months to get in to see a pediatric neurologist in our urban jungle and yesterday was the day.  7 of 8 got to meet her own personal Brain Doctor so we could get a little bit clearer picture of how her right hemisphere is wired.
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To recap, for those new readers out there, our 7 of 8 came equipped with the funniest little lopsided crawl we had ever seen.  It was darling, inelegant, and quite unique.  And then it didn't change...and didn't change....and didn't change.  Clue Number One.  We ultimately ended up with a series of MRI portraiture of the inside of  7's pretty head and were told that she had experienced some sort of stroke around the time of birth, leading to weakness on her left side.

The Brain Doctor yesterday was wonderful. Compassionate, playful, more than happy to meet me at my level and let me ask all sorts of neurological trivia.  I love that, when a medical professional is open and not threatened by a Mama Bear who doesn't claim to know it all, but has taken it upon herself to do a little thing called research.  He validated some of the research I had found, had further suggestions and was able to determine that 7's stroke was ischemic.

There are essentially two types of stroke, ischemic and hemorrhagic.  An ischemic stoke is when there is an interruption of blood flow to the brain.  A hemorrhagic stroke is when the brain experiences a bleed in the brain due to a rupture in blood vessels or injury.  7's type of stroke occurred in a small patch of white matter adjacent to the right ventricle.  (We now interrupt this post to remind you of something from high school biology class...the right side of the brain controls the left side of the body...) It does not appear that the blood flow was impeded by a clot, but rather some sort of small event, such as a blood pressure drop,  that interrupted appropriate blood flow to that area of the brain.  The Brain Doctor told me that different areas of the brain receive different levels of blood volume.  The area of the brain where 7's stroke occurred ordinarily receives the lowest amount of blood flow, one-fifth of the blood flow common to the rest of the brain.  Therefore, this is a common area to see this type of ischemic stroke in infants; it's sort of the last stop on the train route in terms of blood supply.

A couple of areas of good news included his opinion that 7's left leg was left relatively unaffected by the stroke and that the continued strengthening of her abdominals and obliques will ultimately pull her legs into better position.  He estimates that 7 will be walking within the next four months or so, a huge relief to hear as it isn't always clear how far-reaching the impact of a stroke will be.  Her cognitive development seems to be normal and on schedule, appropriate for her age. And Mr. Brain Doctor Sir also believes that 7's stroke occurred in the womb, not at birth, based on the scarring and accommodation of the ventricle to the area of the stroke, or lesion.  This may sound odd, but this lifted the little chip of guilt I had been carrying, as I opted to deliver the twins vaginally instead of through a c-section.  I had questioned myself in light of 7's condition, if the vaginal delivery had been too much for her, even though the birth was incredibly smooth and without any complications or drops in heart rate.  Apparently, the results of the MRI seem consistent with a brain event occurring with an in-utero blood flow interruption.

So, all in all, in that strange way, it was a good day.  7 flirted and babbled and chewed on her pink poodle doll and showed Mr. Brain Doctor Sir her little cruising walk while hanging on to the office chairs.  She slowly blinked her big green eyes at the nurses.  She ate animal crackers, blew kisses and screamed when they weighed her.  We thanked the doctor, thanked the staff and booked our appointment for next year...yes, they book a year in advance.

And then we went back to our daily work of working with her left hand, her dexterity, building strength.  We went back to our daily work of working on her crawl, repositioning her feet, kissing her pudgy cheeks, delighting in her giggles and being thankful again to have her, just as she is.

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