Filimonchik Viktoriia Alekseevna

Filimonchik Viktoriia Alekseevna

Unit: 2^nd No. 1779/16 Age: 1 year 5 months (September 26, 2014)

Discharge report

Date of admission: March 29, 2016

Date of discharge: April 11, 2016

Spent 13 days at hospital

Past medical history:

Child was growing up and developing according to age-appropriate norms. All vaccinations were performed in time. Girl had a case of acute viral respiratory infection. Starting from January 2016 headaches and nausea have developed. According to parents, child has been ill since January 10, 2016, when she started to suffer from daily cases of nausea and vomiting. Had been treated by gastroenterologist and infectionist at hospital, without improving. On March 11, 2016 brain MRI was performed: non-brainstem tumor of posterior cranial fossa was detected.

Currently child is hospitalized to N. N. Burdenko Scientific Research Neurosurgery Institute for surgical treatment.

Clinical presentation:

Main factors in clinical presentation are: evident bulbar palsy (nasal voice, decreased gag reflex on the right, choking), mild facial palsy on the right, hypertensive syndrome (nausea and vomit).

According to brain MRI results there is a tumor of posterior cranial fossa with non-brainstem spreading to right cerebellopontile angle.

Treatment:

On March 30, 2016 surgery was performed: removal of gigantic lateral ependymoma of posterior cranial fossa (4^th ventricular and non-brainstem location on the right) with MEP-monitoring. Satisfactory condition during surgery. Somatic and hemodynamic indicants are stable, within normal range. Augmentation of bulbar palsy is apparent in neurological status after the surgery. Accordingly, surgical tracheostomy was performed on April 04, 2016.

Child was consulted by children’s oncologist prof. O.G. Zheludkova: adjuvant therapy protocol was indicated. Girl requires installation of Ommaya reservoir.

On April 08, 2016 surgery was performed: installation of catheter into anterior horn of lateral ventricle with its connection to subdermal reservoir (Ommaya).

Currently child’s condition is relatively satisfactory. Somatically stable. Spontaneous respiration is through tracheostomy tube. Feeding is through nasogastric tube. External ventricular drain was removed on 6th day, no signs of hypertension.

Postsurgical wound without sings of edema and inflammation, sutures were removed, healing by the first intention.

HIV – negative, syphilis – negative, hepatitis B – negative, hepatitis C – negative.

Verified diagnosis:

Atypical teratoid rhabdoid tumor of 4^th ventricular and non-brainstem location on the right.

Histologic diagnosis:

BIOPSY No. 12586-90/16

dd. March 30, 2016

Pathoanatomical diagnosis: Atypical teratoid rhabdoid tumor WHO grade IV (INI-1, EMA+++, immunohistochemistry of Ki67 up to 50%).

Conclusion and recommendations:

1. Follow-up by neurologist and pediatrician at place of residence.

2. Follow-up and treatment by oncologists.

3. Carrying out of the recommendations of prof. O.G. Zheludkova.

4. Postsurgical sutures are to be removed on April 15, 2016.

5. Follow-up brain and spinal cord MRI with contrast intensifying in one month.

6. Repeated consultation by neurosurgeon of N. N. Burdenko Scientific Research Neurosurgery Institute

with examination results.

No contacts with contagious patients were registered

Doctor in charge /Signature/ M.A. Krasnova

Doctor /Signature/ B.Z. Cheldiev

Department chief /Signature/ A.G. Melikian, M.D.,

higher doctorate

Seal: Cheldiev Batrada Zaurbakovich * Doctor

April 11. 2016

125047, Moscow, 4^th Tverskaya-Yamskaya Str., building 16 Administration (499) 251-6526

Fax: (499) 250-93-51 E-mail: info@nsi.ru Accounting department (499) 251-8666

http://www.nsi.ru Secretariat (499) 251-6304

Stamp: Federal State Autonomous Institution * N. N. Burdenko Scientific Research Neurosurgery Institute * of Ministry of Healthcare of Russia * for references

Federal State Budgetary Institution Russian Scientific Center of Roentgenoradiology
of the Ministry of Healthcare of the Russian Federation

117997 Moscow, ul. Profsoiuznaia Str., 86.

Call-center 8(495) 333-91-20. Commercial services 8(495) 334-15-08

Fax: 8(495) 120-43-60

Department of children’s roentgenoradiology

MEDICAL RECORDS CARD No. 5707/16

Patient: Filimonchik Viktoriia Alekseevna

Date of birth: September 26, 2014. Payment: individual payment

Address: town of Yaroslavl, ul. Uglichskaia Str., house 21, Apt. 14

Consultation of prof. O.G. Zheludkova

Main clinical diagnosis: Atypical teratoid rhabdoid tumor of 4^th ventricular and non-brainstem location on the right. Condition after tumor resection. Stage M0. Condition after 1^st course of polychemotherapeutic treatment.

Patient has tracheostomy. Feeding is through nasogastric tube.

Complains: of fidgeting.

Medical case history: child is ill since January 10, 2016 – single case of vomiting in the morning. On January 13, 2016 – repeated single case of vomiting in the morning. Up to January 26, 2016 – 2-3 case of repeated vomiting per day. Since January 26, 2016 – 5-6 cases of vomiting per day. Had been treated by gastroenterologist and infectionist at hospital at place of residence, without improvement. On February 15, 2016 choking while feeding has developed, nasal voice, multiple vomiting. On February 28, 2016 – ceased walking. Was consulted by neurologist.

On march 11, 2016 brain and spinal cord MRI with and without contrast was performed: mass lesion of 4^th ventricular and non-brainstem location on the right was detected.

On March 18, 2016 facial palsy on the right side has appeared.

On March 29, 2016 child was hospitalized to N. N. Burdenko Scientific Research Neurosurgery Institute for surgical treatment.

On admission - evident bulbar palsy (nasal voice, decreased gag reflex on the right, choking), mild facial palsy on the right, hypertensive syndrome (nausea and vomit).

On March 30, 2016 1^st surgery was performed – removal of tumor of 4^th ventricular and non-brainstem localization on the right, installation of external ventricular drain.

In postsurgical period - augmentation of bulbar palsy. External ventricular drain was removed on 6th day, no signs of hypertension.

Federal state publicly-funded institution

“Federal clinical research center of Dmitriy Rogachev children’s hematology, oncology and immunology center”

DEPARTMENT OF RADIOLOGY

BRAIN AND SPINAL CORD MRI

Full name: Filimonchik Viktoriia Alekseevna

Sex: female Date of birth (age): September 26, 2016 (1 year old)

Payment: by patient

Contrast medium: Magnevist 3 ml

Description: Condition after surgery of mass lesion of posterior cranial fossa. Tracheostomy is installed – evident artifacts of magnetic field shifting are detected – visualization of part of cervical and thoracic spine is absent.

Postsurgical changes of cystic origin are seen on MRI brain projections in area of cerebellum right hemisphere, right cerebello-pontine angle, stem margin and medulla oblongata. Furthermore, local uptake of paramagnetic is observed, associated with contrast medium administration, on the right side of medulla oblongata measuring about 13 mm in length and 9x7 mm in axial plane – negative dynamics comparing to MRI data from April 15, 2016.

Other areas of brain are without abnormalities. Shunt bypass is seen into right anterior horn of lateral ventricle. Mild internal hydrocephalus signs are preserved without evident dynamics.

Additional area of changed MR signal in central canal of the spinal cord is observed, most likely from spinal cord membranes, with contrast medium uptake measuring about 8x7x9 mm at the L3 level – probably of secondary character – negative dynamics comparing to MRI data from April 15, 2016.

No abnormal lesions along the length of central canal of the spinal cord are not firmly seen.

Shape and high of vertebrae bodies is not changes. Structure of vertebrae bodies is rather homogenous.

Intervertebral discs herniation posteriorly is not detected, dural sac is not deformed.

Conclusion: negative dynamics comparing to MRI data from April 15, 2016 manifesting as local segment of contrast in medulla oblongata area and secondary lesion of spinal cord membranes at the L3 level.

X-ray technician: A.N. Remizov /Signature/ Date: July 02, 106

Stamp: Polyclinic * Federal clinical research center of Dmitriy Rogachev children’s hematology, oncology and immunology center * Ministry of Healthcare of Russia * ID 1027739507212 * for certificates

*41945*

DEPARTMENT OF RADIOLOGY

Video-EEG monitoring

Patient’s full name: V.A. Filimonchik

Age: 1 year 9 months

Date of screening: July 07, 2016

Diagnosis: Malignant neoplasm of brain stem. Condition after surgical treatment. Installed Ommaya reservoir, tracheostomy.

Conditions of EEG-monitoring: EEG-monitoring was performed in unipolar lead, electrodes were placed according to international protocol “10-20” with joint referential ear-clip electrodes, with single-channel ECG registration. Sensitivity 10 mkV/mm, speed – 30 mm/sec, High-pass filter – 70 Hz, low-pass filter – 0,5 Hz. Impedance: less than 10 kOhm.

Description: EEG-monitoring was conducted with video registration for 30 minutes. There are multiple artifacts in recording associated with rocking a child. Analyzing traces without artifacts, child’s condition is awake: eyes are always open, attention is captured, with provocation testing (rhythmic photostimulation).

Sedative therapy: finlepsin, atarax.

Conclusion:

background activity is dysrhythmical, poorly organized, main cortical rhythm is registered unmodulated in parieto-occipital areas with range and index more in right hemisphere, index is decreased on the left due to registration in fronto-temporal areas high frequency, high-amplitude monographic artifact during the whole period of screening. Frequency-response characteristics of cortical rhythm (frequency 5-6-6,5 Hz) – at the lower margin of age-appropriate norm. Time of age-related electrogenesis maturing – satisfactory.

Epileptiform activity during wakefulness and provocation testing is not detected.

According to synchronized video registration, no seizures were observed. Few attempts to cry were seen, as so facial asymmetry was reordered, manifesting in flattening of nasolabial fold on the right, shifting of mouth angle, palpebral fissure were not closed – intensification of myographic reset in elecrodes of left hemisphere was detected on EEG.

Recommended repeated screening in dynamics in 4-6 months.

Doctor: O.A. Serdyuk Signature: / Signature/

Stamp: Polyclinic * Federal clinical research center of Dmitriy Rogachev children’s hematology, oncology and immunology center * Ministry of Healthcare of Russia * ID 1027739507212 * for certificates

Federal State publicly-funded institution “Federal clinical research center of Dmitriy Rogachev children’s hematology, oncology and immunology center”

Video-EEG monitoring

Patient’s full name: Filimonchik Viktoriia Alekseevna; Sex: female; age: 1 year

Date of screening: July 07, 2016

Federal State publicly-funded institution “Federal clinical research center of Dmitriy Rogachev children’s hematology, oncology and immunology center”

Video-EEG monitoring

Patient’s full name: Filimonchik Viktoriia Alekseevna; Sex: female; age: 1 year

Date of screening: July 07, 2016

Federal State publicly-funded institution “Federal clinical research center of Dmitriy Rogachev children’s hematology, oncology and immunology center”

Video-EEG monitoring

Patient’s full name: Filimonchik Viktoriia Alekseevna; Sex: female; age: 1 year

Date of screening: July 07, 2016

Federal State publicly-funded institution “Federal clinical research center of Dmitriy Rogachev children’s hematology, oncology and immunology center”

Video-EEG monitoring

Patient’s full name: Filimonchik Viktoriia Alekseevna; Sex: female; age: 1 year

Date of screening: July 07, 2016

Federal State publicly-funded institution “Federal clinical research center of Dmitriy Rogachev children’s hematology, oncology and immunology center”

Video-EEG monitoring

Patient’s full name: Filimonchik Viktoriia Alekseevna; Sex: female; age: 1 year

Date of screening: July 07, 2016

Federal State publicly-funded institution “Federal clinical research center of Dmitriy Rogachev children’s hematology, oncology and immunology center”

Date and time: July 07, 2016 03:00

Patient’s full name: Filimonchik Viktoriia Alekseevna

Patient’s ID: 41945

Date of birth/age: September 26, 2014 (21 months 1 week)

Medical records card No.: 2016/37953

Bronchoscopy

Instrument: Pentax(45)

Anesthesia: Combined

Trachea: Lingual tonsil is not enlarged. Vallecular sinuses are free. Pyriform sinuses are free. Larynx: arytenoid cartilages are not changed. Vocal cords are without abnormalities. Glottis is wide. Subglottic space is free. Tracheal lumen is not deformed, well-passed, at the C3 level of trachea is tracheostomy on frontal wall. Mucosa of trachea, main bronchi, lobar and segmented bronchi is pale-pink, smooth, vessel pattern is preserved. Slight serous drainage on lobar and segmented bronchi of both lungs is observed. Bronchial tree lumen is not deformed.

Cytology performed: no

Biopsy performed: no

Conclusion: installed tracheostomy

Neurologist

Date and time: July 04, 2016

Consultation of medical specialist, candidate of medical sciences

Medical records card No.: 41945

Patient’s full name: Filimonchik Viktoriia Alekseevna

Age: 21 months 1 week

Date of birth: September 26, 2014

Place of residence: Yaroslavl oblast, town of Yaroslavl, ulitsa Uglichskaia Str., house 21, Apt. 14

Complains: of disordered motor activity of right limbs, swallowing difficulty (installed tracheostomy, nasogastric feeding).

Medical case history: surgical treatment of atypical teratoid rhabdoid tumor, currently metastases in spinal cord are present.

After surgery child has been receiving Carbamazepinum 100 mcg per day, also she was receiving valproic acid.

Conscious condition: communicative, answer on demand.

Psychomotor development: stands holding the support, walks with assistance.

Cranial nerves: pupils: shape – normal, width – S=D, reactive to light, convergence is preserved, palpebral fissures D<S, eyeglobes mobility is not limited, no strabismus, no nystagmus. Trigeminal spots palpation is painless. There is a paresis of mimic muscles on the right, swallowing difficulties. Bulbar palsy is present. Tongue deviation to the right is observed.

Muscular strength: decreased in right limbs to 3,5-4 points.

Muscular tonus: hypotonia

Hyperkinesis: none

Coordination test performed: picks up toys confidently.

In Romberg's position: static ataxia

Walking: with support hemiparetic

Sleeping disturbances: sleep is troubled

Examination plan: oncologist consultation

EEG during wakefulness

Treatment plan: continue administration of Carbamazepinum (finlepsin) 100 mcg per day

Hydroxyzinum (atarax) 0,025 as ¼ of a pill before bed, 1/8 of a pill twice daily in the morning/at noon.

Date of examination: July 04, 2016

Diagnosis: C7.1 Malignant neoplasm of brain stem

Clinical description: Right-sided hemiparesis, bulbar palsy. Installed tracheostomy.

Ophthalmologist

Date and time: July 04, 2016

2.2 Repeated consultation of medical specialist, doctor of medical sciences (higher doctorate)

Medical records card No.: 41945

Patient’s full name: Filimonchik Viktoriia Alekseevna

Age: 21 months 1 week

Date of birth: September 26, 2014

Place of residence: Yaroslavl oblast, town of Yaroslavl, ulitsa Uglichskaia Str., house 21, Apt. 14

Complains: of OD redness

STATUS OCULORUM: Vis OD = spatial vision

Vis OS = spatial vision

Deviation: OD – converg to 10

Eyeglobes position in orbit: height OD<OS

Eyeglobes mobility: OD limited mobility outwardly. Fine nystagmus is observed periodically in direct look. Eyelids closure is incomplete in OD.

On examination: OS is quiet. OD – conjunctival injection.

Cornea: OD – multiple areas of keratopathy. Corneal reflex is absent in OD.

Pupil: OD<OS. OD – photoreaction is direct and consensual OD<OS.

Eye fundus: OD – behind the haze. OS – optic disc is pale-pink, with sharp contours. Pathway and caliber of vessels is almost unchanged. MZ, periphery is without abnormalities.

Additional methods of examination: soft contact lens on OD

Conclusion: Paresis n.abducens, n.facialis, n.ophthalmicus. No data on intracranial hypertension in eye fundus was obtained. OD – eye fundus is behind the haze.

Recommendations: 1. Soft contact lens sph-0,5 BC 8,2 for the right eye (scheduled replacement once every 7-10 days)

2. Corneregel®/ Solcoseryl® 8 times per day into right eye,

3. Complete occlusion of right eye during sleep.

4. VitA-pos® apply on lower eyelid before bed.

Date of examination: July 04, 2016

Diagnosis: H49.2 Sixth [abducent] nerve palsy

Clinical description:

Time of examination: 10:35

Otolaryngologist

Date and time: July 04, 2016

Consultation of medical specialist

Medical records card No.: 41945

Patient’s full name: Filimonchik Viktoriia Alekseevna

Age: 21 months 1 week

Date of birth: September 26, 2014

Place of residence: Yaroslavl oblast, town of Yaroslavl, ulitsa Uglichskaia Str., house 21, Apt. 14

Complains:

of disordered motor activity of right limbs, swallowing difficulty, installed tracheostomy.

Medical case history: on March 30, 2016 surgical treatment of atypical teratoid rhabdoid tumor was performed, on 5^th day tracheostomy was performed due to bulbar palsy development. Feeding is through nasogastric tube and also anatomically naturally. Choking troubles, liquids and solids sanitize from trachea. Currently patient has metastases into spinal cord.

Rhinoscopy: nasal respiration: conducted, on right side – nasogastric tube. Nasal cavity mucosa is pale, wet. General nasal passages: without abnormal secretion.

Pharyngoscopy: oropharyngeal cavity: palatine arches: contour sharply, of pink color, palatine tonsils: at the level of palatine arches, of elastic consistency. Posterior wall of pharynx is of pink color.

On external examination and neck palpation: on anterior surface of the neck at its usual position is tracheostomy with loaded cuffless tracheostomy tube Bivona No5,5. Mother takes care of tracheostomy and tube herself, she is able to change it herself once a week.

Conclusion: tracheostomy. Constant bearer of tracheal tube. Dysphagia. Bulbar palsy.

Recommendations: Diagnostic fiber-optic laryngotracheoscopy under anesthesia.

- Replacement of tracheostomy tube on tube No.4 with a cuff, preferably by Shiley.

Otolaryngologist

Date and time: July 06, 2016

2.2 Repeated consultation of medical specialist

Medical records card No.: 41945

Patient’s full name: Filimonchik Viktoriia Alekseevna

Age: 21 months 1 week

Date of birth: September 26, 2014

Place of residence: Yaroslavl oblast, town of Yaroslavl, ulitsa Uglichskaia Str., house 21, Apt. 14

Examination: child with diagnosis: tracheostomy. Constant bearer of tracheal tube. Dysphagia. Bulbar palsy.

Treatment conducted at time of examination: Replacement of tracheostomy tube was performed (cuffless tube No.5,5 was installed) on tube No.4 with expansion cuff system. Procedure went well. Tracheostomy channel is well-formed. Respiration through tracheostomy is satisfactory.

Recommendations: - due to mother’s attempts to fees a child through the mouth, it is recommended to try this with expanded cuff.

- Consider installation of gastrostomy with treating doctors.

BIRTH CERTIFICATE

_________________________________ Filimonchik ___________________________________

last name

________ ______________________Viktoriia Alekseevna _______________________________

name, patronymic

was born on ______________________ September 26, 2014 ____________________________

date, month, year (in words and in figures)

____________________(twenty-sixth of September, two thousand fourteen) _______________

place of birth: _____________________ town of Perm ____________________________________

__________________________________ Perm Krai_ ____________________________________

________________________________ Russian Federation _______________________________

the entry whereof was made in the Birth Register on the 01^st of October of 2014 under No. 1467

Father _______________________________ Filimonchik ________________________________

last name

________________________________ Aleksei Viktorovich ______________________________

name, patronymic

___________________________________ Russian ______________________________________

citizenship

Mother______________________________ Filimonchik _________________________________

last name

___________________________________ Olga Iurevna ________________________________

name, patronymic

____________________________________ Russian _____________________________________

citizenship

Place of state registration: _________ Department of Civil Status Registration Office of town of Perm administration (Ordzhonikidze department) of Perm Krai_______________________

(name of Civil Status Registration Office authority)

Date of issue: October 01, 2014

Head of Civil Status Registration Office authority ____/ Signature/____ Iu.V. Melnichuk

Seal: Town of Perm administration * Department of Civil Status Registration Office of town of Perm administration Ordzhonikidze department * Coat of Arms of Russian Federation

III-ВГ No. 601860

57 14 183790