Thursday

Today, we had an acedmic conference to discuss how to evaluate a blind patient. On 8A, we have a 12 year old girl who has experienced progressive bilateral blindness for one year. She had a previous diagnosis of optic neuritis and was treated with steroids. She is now totally blind bilaterally although she has no other neurologic symptoms. She came to Katutura Hospital for further evaluation. A CT scan of the head suprisingly revealed hydrocephalus and a tumor in the cerebellum. Due to the hydrocephalus and the location of the tumor, the presumed diagnosis of tuberculosis meningitis was made and she was started on treatment. She is now awaiting evaluation by the neurosurgeon for placement of a VP shunt. TB meningitis continues to be one of the most common diagnoses that we see here, one that is very uncommon in the US.
We also experienced another afternoon in the POPD (outpatient clinic). Anna had two interesting patients. A 3 month old male with macrocephaly and signs of increased intracranial pressure who was admitted for evaluation for VP shunt placement by neurosurgery. It is amazing the number of cases of hydrocephalus that we have seen here. Often, the cause is due to TB meningitis. She also saw a 7 month old patient who had been treated repeatedly for chronic constipation. On further examination today, it was felt that she may have an abdominal mass so she was admitted for further work-up. It seems that every afternoon, we see patients with interesting diagnoses. Today, I felt like I was back a Knapper seeing patients with diarrhea, atopic dermatitis and URIs. It is sometimes nice to see that African children can have many of the same illnesses that American children have.
We are looking forward to the radiology conference tomorrow morning where we can view and discuss all of the images of the patients from the week on the wards with the radiologist.