17-02-2026
THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HER GUARDIAN'S INFORMED CONSENT. HERE WE DISCUSS OUR PATIENTS PROBLEMS THROUGH SERIES OF INPUTS FROM AVAILABLE GLOBAL ONLINE COMMUNITY EXPERTS WITH AN AIM TO SOLVE THOSE PATIENT'S CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUTS.
[10:46 am, 17/02/2026] PPM 1: We need to see the clinical and radiology MRI images
[11:06 am, 17/02/2026] PPM 1: Deidentified clinical images of of her head and MRI or CT images needed
[11:14 am, 17/02/2026] PA: K sir I will send it sir.
[1:21 pm, 18/02/2026] PPM 1: @PPM3 considering your interest in neurosurgery and the fact that we need to make a quick decision regarding this child's neurosurgery, can you with the help of @PPM4 @PPM5 @CR take her complete history details and clinical and MRI images by interviewing her patient advocate over a call whenever you can manage at a mutually agreed time?
[1:47 pm, 18/02/2026] PPM 3: Sure sir I'll contact the patient advocate right away
Follow up:
After 2 weeks- Consultant Neurosurgeon
After 10 days- Consultant Paediatrician
[9:53 am, 07/03/2026] PPM 1: How would you explain the downward deviation of the eyes in this patient's mother's initial complaint a month before she noticed the large head? @PaJR Health
[9:53 am, 07/03/2026] PaJR Health: Based on the clinical records and established medical literature, the downward deviation of the eyes observed in this infant is a classic neurological finding known as the *"Setting Sun Sign."*
*CLINICAL EXPLANATION*
🔹 *PERIAQUEDUCTAL PRESSURE*
The downward deviation is not typically caused by the "weight" of the head or mechanical displacement of the eyeballs. Instead, it is caused by increased intracranial pressure (ICP) affecting the midbrain. Specifically, the pressure impacts the *Sylvian aqueduct* and the *pretectal area*, which are responsible for controlling upward eye movements.
🔹 *UPWARD GAZE PALSY*
Because the pressure impairs the nerves that allow the eyes to look up, the eyes appear to be "pushed" downward, often leaving a visible rim of white sclera (the white of the eye) above the iris. This is frequently one of the earliest signs of hydrocephalus, often appearing before the head circumference increases significantly.
🔹 *RELATION TO VEIN OF GALEN MALFORMATION (VOGM)*
In this specific case, the *Vein of Galen Malformation* (a rare vascular abnormality) causes a significant volume of blood to shunt through the brain, which often leads to rapid-onset obstructive hydrocephalus. The mother's observation of the eye deviation a month before the head size became noticeably large suggests that the internal pressure was already affecting the midbrain centers before the infant's skull sutures expanded enough to show a "large head."
*SUMMARY OF FINDINGS*
📋 *Case Record:* 2 month old girl with severe hydrocephalus recently diagnosed Telangana PaJR
💡 *CLINICAL NOTE*
The fact that the eye deviation preceded the head enlargement is a critical clinical detail. It indicates that the hydrocephalus was likely "acute" or "subacute" in its development, creating enough pressure to cause neurological signs (the eyes) before the physical structure of the skull (the head size) could compensate by expanding.
1. Sylvian aqueduct syndrome as a sign of acute obstructive hydrocephalus in children - https://pubmed.ncbi.nlm.nih.gov/1151409/
[10:06 am, 07/03/2026] PPM 6: नमस्कार, पुनर्वास चिकित्सा प्रश्न पर मुझे @ करे🙏🏻
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