4/5

Apologies for the delay in updating, I realize many of you have likely been checking in here to find out the latest.  It has been a hectic week.

Well, we've had a bit of a setback.

I took Dad in to the ER on Sunday 4/1 for stroke symptoms.  He had onset of significant left arm and left hand weakness, slight left-sided mouth droop, and significant left peripheral vision loss.

He was seen immediately in the ER where I work and was quickly evaluated by the Neurology service.  Initially he was admitted for stroke and the whole stroke work-up was ordered.  He remains in the Neurology IMC (Intermediate Care Unit) at Hershey Medical Center.

I'll spare a lot of the details over the past week, but after some tests it no longer appears that he had a stroke (which is good news).   His MRI shows that he has superficial tissue damage to the back right part of his brain.  That tissue is "angry" but not dead.  This is not consistent with strokes, which show deeper brain involvement and usually an actual death of brain tissue.

So then the question arises, what is it?

Initially his neurologist, Dr. Reichwein, had 3 possibilities:  1) inflammation 2) infection 3) seizure.  To narrow this down, he had a lot of tests ordered, most notably EEG (to look for seizure activity) and a lumbar puncture (LP) to check his CSF (cerebrospinal fluid) for signs of infection or inflammation.

We're still waiting for the EEG to be done, but he had the LP and the results are consistent with inflammation.  The CSF was also sent out to test for recurrence of the viral infection that caused his encephalitis back in December, but those results won't be back for a couple of days.

Right now he is being treated with IV steroids for inflammation and also IV Acyclovir pre-emptively just in case the CSF comes back positive for infection.   Dr. Reichwein is fairly certain that there is no infectious process or recurrence of his encephalitis, but we'd rather treat with the Acyclovir as a precaution.

So then the question is, how did he get this brain inflammation?

It is related to his encephalitis, but Dr. Reichwein said it's highly unusual for this to occur.  His current thinking is that when my dad originally got sick in December he had the infection (which was treated) and the inflammation (which was expected to resolve after the infection did).  The infection went away but the inflammation didn't.  Further, (and this is the part which is highly unusual), he thinks that the inflammation may have migrated from the site of his infection (middle of the brain) to the back of the brain.   The treatment for this is IV steroids.

Currently he has improved (even before we started the steroids).  His left arm is just as strong as his right arm now, although he has still has issues with left hand finger dexterity.  The mouth droop is basically gone.  He still has a significant left-peripheral vision deficit, but it has gotten slightly better in the lower part of his visual field.

The plan is to keep him in the hospital until at least Monday to get the IV steroids, monitor him, possibly repeat the MRI, and do the EEG.  He may also go home on oral steroids, depending on his progression.

What I find interesting is that the site of his current inflammation (and his pain) is the back right of his head - the same place he's had pain all along.  Dr. Reichwein agreed that he may have had this inflammation brewing for awhile.

So, that's the current update.  He's bummed to be in the hospital, but dealing with it well.  Mostly just annoyed to be hooked up to so many cords and wires.  We're disappointed that he has to spend another holiday all cooped up.  We celebrated Christmas in the hospital, now Easter too.  But we plan to have an egg hunt for the kids in his room and we'll open their Easter baskets there Sunday morning.  Should be interesting if we don't find all the eggs, the next patient in that room will get a nice surprise!