Doctors Lounge - Neurology Answers
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Forum Name: Neurology Topics
|cvette66 - Fri Mar 27, 2009 7:31 am||
This is a question about my brother who we just found out was born with a fused skull in 1959. An operation was done (groundbreaking at the time) to insert plastic as a substitute "soft spot". My parents were given strict orders to make sure that it was removed before my brother turned 18. It never was removed. I just found this out. From what I can gather the doctors in Rochester, NY made a huge effort to have my parents bring my brother in to remove the plate.
At the age of 50, my brother has severe problems with concentrating and also with depression. He cannot focus on anything and has issues from dealing with anger to making decisions and is very frustrated. My other two brothers and I are very successful in our careers and are basically "go-gettters". I know everyone is different but this brother is really struggling in life. He is being treated for depression and adult AD&D but nothing helps. He is socially awkward, struggles keeping a job yet can recall specific dates and events from our early childhood that we have all forgotten.
Can this be a result of something going on in theb rain with this plastic plate? Will it get worse? Do you have any recommended courses of action we should look into?
Can a brain scan tell us anything? We do not know who the original doctors were and it was 50 years ago. Thank you.
|John Kenyon, CNA - Mon Apr 20, 2009 10:28 pm||
Your brother's surgery was done at the time of a lot of "groundbreaking" procedures that really did open a lot of doors and provide a lot of useful information for future surgical candidates. However, some of these early surgeries could, in hindsight, have been done differently to better effect. Others turned out remarkably well. It's difficult to recover records due to time and chances in record keeping as well as doctors having retired or died. What we can know is the history of these patients. First, it's unclear whether children born with untreated fused skull do, in fact, suffer any early developmental problems. What is certain is they don't seem to suffer late onset of problems such as you describe. If your brother's problems have surfaced recently it's more likely tthey are due to other, medical or situational causes, and should be examined in that light. As for the prosthetic fontanelle, it most likely has been subsumed by bone growth, and the underside might be resting near the top of the brain, doing no direct harm. It would have been tricky, in the mid 1970s, to remove the thing anyway. Now it's probably a moot issue. If the plastic itself did not release toxic byproducts (and plastics have changed a lot in medical circles over the past half-century), then I strongly suspect the problems are due to something else, and there is a great variation not only in personalities, but in who may be subject to mood disorders or other physical problems. The fact that there's a bit of foreign material in there has to come into question, but the likelihood is it's not to blame for the changes in your brother -- if they are changes. If they've been going on for many years, there could have been some damage done early on, but again the cause would be moot now and in either case the problems should be treated as though they exist on their own.
An MRI study should be able to visualise the plate, and of course if it's location shifted and it's in contact with his brain, then there's a whole different situation to consider. Both a neurological and psychological evaluation should be done, in tandem, with an eye toward ruling out any mechanical "touching" and if that isnegative, then the problems can be treated as per usual.
I hope this is helfpful to you. Good luck to you and please follow up with us here as needed.
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