case_images: PMC3825224_01
case_images: Laboratory, TCD and EEG data. A. Selected laboratory results showing changes in liver enzymes and synthetic function beginning with admission of day of life (DOL) 5. B, Continuous EEG on DOL7 showing focal bifrontal and bitemporal epileptiform discharges. C. Serial transcranial doppler results showing undetectable end-diastolic (ED) velocities in the middle cerebral artery on DOL 11 during hypothermia and DOL 14 after rewarming, with recovery of flow during head cooling on DOL 12 and early after re-warming on DOL 14. Time-averaged mean of the maximal velocities (Tamx) show initial reduction in velocity during cooling, followed by recovery. D, Continuous EEG on DOL13 showing right sided electrographic seizure. ALT, alanine aminotransferase; AST, aspartate aminotransferase; TCD, transcranial doppler.
case_images: 40064_2013_625_Fig1_HTML.jpg
case_images: PMC3825224_01_40064_2013_625_Fig1_HTML.jpg
case_images: Fig1
case_images: Additional laboratory abnormalities included ferritin > 100 000 ng/L, INR 4.5, lactate 5 mEq/L, with a rising AST (Figure 1A). Routine EEG detected focal bifrontal and bitemporal epileptiform discharges, but no seizures [Figure 1B]. TCDs showed absent diastolic MCA flow (Figure 1C), suggesting increased ICP. The next morning, she had non-suppressible bilateral arm jerking, tachycardia and desaturations, which resolved with phenobarbital (Figure 1D). TCD showed increased diastolic flow (Figure 1C).