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