Monday, September 14, 2015

The Brain

The brain can be a mysterious thing...

While we were admitted in the hospital for Emily's EEG, she had a rapid MRI done to check the shunt (standard procedure for any symptom that could be shunt related.)

Our neurologist wanted to go over the results with us so that we had a better idea of Emily's prognosis for development.  First of all, he said that if anyone tells you that you can predict what she will do based on scans of her brain, they would be lying to you.  That being said, it appears that her entire occipital lobe is missing and large parts of her temporal lobes.  Basically the only part that looks perfect is her brainstem and her frontal lobe looks good.  Based on this, you would guess Emily is completely blind.  However, she can clearly see.  In fact, she seems to see well.  We don't know what her brain is interpreting as far as sight and it depends on her being able to tell us to know for sure.  Thanks to neuroplasticity and maybe the cord blood infusions, other parts of her brain have taken over for the parts that are damaged. Her neurosurgeon has a different opinion though- he thinks there hasn't been enough time for the fluid to drain to determine what parts of her brain are missing and/or damaged, hence why he hasn't ordered an MRI specifically for that purpose yet.  He said it will take years before that can be done.  I never would have guessed that doctors could have different interpretations of clear-cut scans, until I was immersed in this world of hydrocephalus.  Doctors also have different opinions on whether her corpus calossum, the small bundle of nerves connecting the two hemispheres, is partially absent, underdeveloped, or just very thinly stretched from the large amount of fluid.  We know it's not completely absent, because you can see a small portion of it on the MRI.  But the part you can see, is thinner than it should appear.  She is also missing her septum pellucidum, which is not up for debate.  This is one of the first structures, along with the corpus callosum to "blow out" when you have severe hydrocephalus, so it is a common finding.  Our neurosurgeon assured us that the septum pellucidum doesn't have much influence on her outcome.

Overall, how a brain looks on a scan doesn't determine how a child will do clinically.  A child with a "bad-looking" MRI can look great clinically, while a child with a "perfect" MRI can be doing poorly clinically and vice versa.
The corpus callosum and septum pellucidum are the two parts in the middle of the brain.



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