New onset-seizure in a 9y/oF

Patient is a 9y/o F with a PMH of sickle cell disease who presented to the emergency department with new onset seizure. Parents thought patient had a tactile fever and cough at home over the past two days. At the OSH CBC demonstrated hgb of 6.3 (baseline 7.0), and with normal reticulocyte count base don disease.

On our exam here patient  had right sided weakness RUE > RLE, and "knew the words she wanted to say, but was unable to effectively communicate them" (what type of aphasia and where is the lesion?)

CTH was unrevealing and patient was transferred to our PICU.

MRI/MRA of the brain was completed that demonstrated:

MRI  brain  without  and  with  contrast:  Patchy  areas  of  restricted  diffusion  and

hyperintense  FLAIR  signal  throughout  several  portions  of  left  cerebral

hemisphere  primarily  at  the  left  middle  cerebral  artery  territory  (including

left  parietal  lobe  cortex  at  superior,  mid,  and  inferior  levels,  left  lentiform

nucleus,  left  internal  capsule  posterior  limb,  left  caudate  body/periventricular

region,  and  superior  left  frontal  lobe  cortex).  Increased  vascularity  of  left

cerebral  hemisphere  on  postcontrast  series  in  the  affected  regions  may  represent

luxury  reperfusion.


Exchange transfusion was begun with placement of a quinton catheter and a goal HgS < 40%, and a Hct > 21%.