Kristy Glover

Medical Information

Birth.  Abnormalities of mid-right ribs.  Chest revealed pectus excavatum.  Absence of the posterior lamina in the mid-line from approximately T-7 through S-2.  65 degree, long, sweeping, kyphosis (from T9 to L5).  Tightness in external rotators and hamstrings.

MRI showed cervical medullary kink located at C5-C6.  She has a dorsal interhemispheric arachnoid cyst.  Corpus callosum is dysplastic.

Original diagnosis of low level (S1) spina bifida with marked hydrocephalus and hypotonia.  Currently T12, secondary to tethered cord, dermoid and lipoma (19 months), retethering and resection at T-12. 

Tegretol toxicity in February of 1995.  Nystagmus began on a regular basis following toxicity. 

In Sept 1995 CCTV monitoring in which two spells were documented, seizures were confirmed.  Description of seizures:  Kristy will tell you 4 to 5 minutes before.  She begins with gagging.  Sometimes her eyes will roll.  She is able to answer questions through the entire event.  She gets pail and damp.  The seizure lasts 2 to 3 minutes.  Seizure is localized in the occipital lobe region and is brought on by visual simulation. Seizure type, partial complex focal seizures.  See 9-26-95.

Current shumt - Small - PL1 - Delta Shunt.  See 8-13-97.

CURRENT MEDICATIONS

Ducolax Suppositories 10mg - 1 at HS QOD
Depakote 375mg - BID

ALLERGIES

LATEX - anaphylaxis
Morphone - extreme aggitation
Dilaudid - extreme aggitation
Nubain has worked well in the past.

DATES OF SURGERY

3-11-87    (1)    Closure with a Rhomboid flap (by Dr. McCoy).  Opening measured 15cm x 20cm is diameter.  External   shunt (by Dr. Robert Beatty).  Childrens Mercy, Kansas City.
3-18-97     (2)    Internal shunt.  Childrens Mercy, Kansas City.
4-10-85     (3)    Shunt revision.  Low pressure accuflow system.  Childrens Mercy, Kansas City.
9-25-87     (4)    Eye surgery for strabismus.  Four muscles cut.  Childrens Mercy, Kansas City.
2-24-88     (5)    Shunt revision.  Medium pressure.  Childrens Mercy, Kansas City.
10-12-88   (6)    Release of tethered cord, removal of diastematomyelia, section of tethered filum and removal of 2 of 3   dermoids.  A lipoma in the left lima of the diastematomyelia was not compressing the cord and was left.  (Dr.   David McClone).  Childrens Memorial, Chicago, IL.
1-1-91       (7)    Shunt revision.  Increased to high pressure.  Childrens Mercy, Kansas City.
2-18-91     (8)    Shunt revision.  Old catheter left in because of concern of it having attached to a blood vessel.  Childrens                           Mercy, Kansas City.
6-6-91       (9)     Chiari II decompression.  C1-C5 laminectomy and tutoplasty duraplasty.  Childrens Memorial, Chicago, IL.
7-12-91   (10)     Kyphectomy with Zelkie posterior internal fixation.  Implant without fusions technique with pedicle screws    and vertebral body carpectomy.  The idea was to instrument her to support her spine in a straighter position    while allowing continued growth without fusion, in addition transfer of perispinous muscles were performed in    order to make the "perverted flexors" of the spine into extensors.  
   Lumbar kyphus, Lindseth flexible Type A myelomeningocele kyphosis, smooth and non-angular.  She    underwent decancellation-kyphectomy, internal fixation in compression over 5 levels with the intermediate    areas undergoing decancellation and a posterior collapsing wedge osteotomy.  An excision vertebrectomy    was not entertained.  Childrens Memorial, Chicago, IL.
12-23-91 (11)    Shunt revision.  Medium pressure system.  Childrens Mercy, Kansas City, MO.
10-13-92 (12)    Muscle flap to cover exposed rods.  Rods re-exposed for several weeks until revision of  rod could be                            rescheduled.  Childrens Mercy, Kansas City, MO.
11-25-92 (13)    Revision of spinal instrumentation with extension of instrumentation to sacrum.  Childrens Memorial, Chicago,    IL.
4-18-93   (14)    Revision of left distal rod of spinal instrumentation.  Childrens Memorial, Chicago, IL.
7-30-93   (15)    Shunt revision.  An addition of an antisiphon valve.  University of Missouri, Columbia.
 8-3-93    (16)    Hamstring resection.  University of Missouri, Columbia.  
12-20-93 (17)    Removal of Zelkie rods.  Nissen fundoplication and gastrostomy tube placement for gastroesophageal    reflux disorder and failure to thrive.  University of Missouri, Columbia.  
1-30-95   (18)    Posterior spinal fusion.  Resection of kyphosis with carpectomies at T-12, L1 and L-2.  Osteotomy of the   mid thoracic spine at approximately T7-T8 level.  Instrumentation of posterior fusion of osteotomy site of   T-12 through L-1 with Isola instrumentation and pedicle screws in the midthoracic spine and in the lumbar   spine.   
  4 days post op became lethargic with headache.  See surgery note of 2-3-95.  8 days later the patient was   noted to have new onset and nystagmus in all direction with maximal eye movements and progressively more   lethargic.   Tegretol levels were drawn and Tegretol was increased as levels were low.  On 2-11-95 Dr.   Lastra, neurology, was contacted.  He believed she was toxic on Tegretol, was seizing and showed signs of a   minor stroke.  Speech pathology evaluatoin  concerred with this diagnosis.  University of Missouri,  Columbia. 
2-3-95     (19)   Ventricles appeared larger than previous CT.  Proximal exploration of ventriculoperitoneal shunt.  The   ventriculoperitoneal shunt was functioning well.  University of Missouri, Columbia.  
11-23-96 (20)   See below note.  Irrigation, debridement and removal of infected spine hardware on November 23, 1996.    Removal of posterior segmental instrumentation, exploration of spinal fusion, lumbar interspace arthrodesis,   local bone graft, irrigation and debridement.  University of Missouri, Columbia.  
1-6-97     (21)   Tethered Cord Release.   Thoracic - roots were identified on both sides and seen to exiting through the   respective foramina.  Most of the lower part of the sacrum, the scar tissue was thickened and dura was   transected and allowed to be free from tension.  The release was done circumferentially.  Because the   resection of scar tissue a large defect was left, this was covered with a piece of cadaveric dura measuring   2x6cm.  University of Missouri, Columbia.  
2-11-97   (22)   Removal of infected spinal hardware.  Isola instrumentation.  Infected with Staphylococcus Coagulase   negative.  Resistant to oxacillin.  Sensitive to vancomycin and tetracycline.  Prior to surgery hemoglobin was   over 14.  After hydration for surgery hemoglobin was 6.  University of Missouri, Columbia.  
2-20-97   (23)    Left external jugular single lumen Port-A-Cath.  University of Missouri, Columbia.  
5-15-97   (24)    Ileocystoplasty, appendiceal metrofanoff catheterizable stoma, anterior urethropexy, suprapublic tube   placement.   Seizures secondary to no Depakote for 2 days.  Nubain for pain.  Worked well.  University of   Missouri, Columbia.  
7-9-97     (25)    Revision of decancellation kyphectomy with titanium isola instrumentation and pedicle screws - T5-S.    During the procedure she lost 3000cc of blood and was given 6 units of PRBCS and 5L of crystalloid.    Dr.   Sarwark.  Childrens Memorial, Chicago, IL. 
  Description                                  Mfg.                 Catalog No.      Lot No.      Qty
  Cable, DBL, Titanium            Danek              826.211          06821              4
  Titanium Screw                       Acrmed          2223-2440                                2
  Spinal Rod 1/4                        Acrmed          5200-1518                            2
  Slotted Connector                    Acrmed          5200-55                                2
  Crosslink Connector 1/4           Danek              811-403  
7-11-97   (26)   Ventriculo Peritoneal Shunt revision, right side.  Valve, Delta, Regular PL-2.  Mfg - MDTRNP.  Catalog No.   42824.  Lot No. K4904.  Replaced valve.  Urine Pseudomonas Aeruginosa.  Dr. McClone - Childrens   Memorial, Chicago, IL.  
7-14-97   (27)   After being placed in reverse trendelenburng she developed collections of fluid in her lumbar spine which was   thought to be drainage from the VP shunt.   Possible abdominal infection.   Removal of ventricular peri-toneal   shunt, right.  Insertion of external ventricular drain, right.  Dr. McClone - Childrens Memorial, Chicago, IL.  
7-21-97 (28)     Ventriculoscopy.  Removal of external ventricular drain, right.  Insertion of ventriculoperitoneal shunt, right.   Valve, Delta, Small PL-1 - Mfg. MDTRNP - Catalog No 42812 - Lot No K4660.  Cath, peritoneal, open  end - Mfg. MDTRNP - Catalog No 43522 - Lot No K4229.  Cath, inner vision, w/slit tip - Mfg.  MDTRNP27070 - Lot No 1058A.  Dr. Grant.  Childrens Memorial, Chicago, IL.
8-13-97(29)     Ventriculoscopy.  Insertion of ventriculoperitoneal shunt, right.  Valve, Delta, Small PL-1 - Mfg. MDTRNP - Catalog No 42812.  Cath, peritoneal, open end - Mfg. MDTRNP - Catalog No 43522.  Dr. Grant.  Childrens Memorial, Chicago, IL.
9-9-97 (30)     Distal ventriculoperitinal shunt blockage, shunt exploration with valve and proximal ends open.  Distal slits clogged with fibrious material.  System flushed and cleaned.  Closing pressure 10cm H2O.  Dr. Jiminez.  University of Missouri - Columbia.  
1-01 (31)         Spinal Cord resection – Dr. Jiminez.  University of Missouri – Columbia.  
12-28-01 (32)  Removal of left external jugular single lumen Port-A-Cath.  All Childrens Hospital, St. Petersburg, Florida.
 
OTHER SIGNIFICANT DATES
3-23-87            Transfusion
6-12-87            Pneumonia  
1-11-88            Dr. McClone felt the shunt reversed a typical quadrigeminal area cyst.  He recommended not to revise and try  to place into ventricular system unless malfunction.  
5-16-91            X-rays showed increase from 65 to 78 degree in kyphosis.  There is an acute take-of at the lumbosacral                          junction.  
7-12-91            Transfusion.  Grandmother's blood used.  
11-25-96          Transfusion 2 units - unknown donor.  
7-97                 EKG and Echocardiogram.  
7-97                 Pulminary Function Tests.  
7-9-97             Transfusion 6 units - unknown donor.  
7-20-97           CSF Culture - In Thio Broth Staphylococcus Epidermidis - Possible Contamination.  Erythromycin-resistant, penicillin G-resistant, vancomycin <2-susceptible, clindamycin .5-susceptible, trimeth/sulf <2/38-susceptible, gentamicin <1 susceptible, cephalothin >16-resistant, oxacillin >4-resistant.
 
GENERAL NOTES  
1991                Hips full flexion to 120 degrees, 5 degree flexion contracture on the right, 10 degrees on the left, symmetrical abduction of 160 degrees, lateral rotation bilaterally of 80 degrees, medial rotation of 10 degrees.  Popliteal angles are 60 degrees on the right, 30 degrees on the left.  Feet are both planti-grade.  
7-93                Wt 16kg, Ht, Head 50.8cm, pulse 144, Head shape is dolichocephalic, Ht 95.5cm.  
2-4-94             Dr. Garcia said may use some benzodiazepines to improve hyperactive gag reflex.  
9-19-94           Eyes - right sph -0.0 cyl +0.75x31 - left psh -0.0 +1.75x147  
12-28-94         Height 104.1, weight 18.6, head 52cm.  Physiologic and lateral gaze nystagmus.   
1-30-95           Kristy consistently received 5/5 strength UE.  Following the episode 1/30/95 she received a 4- on the left and a 4+ on the right.    She has decreased biceps and triceps strength on the left abduct.  She had sensory to L-1 dermatomes and spotty at L3-L4 dermatomes, better on the right than the left.  Deep tendon reflexes are +2/4 in the upper extremity.  She has decreased fine motor skills with breakdown on the left, pincher movements back.   
9-26-95           CCTV 94 hour monitoring.  No tonic/clonic activity.  “Testing is abnormal and shows that the patient’s episodes correspond to seizure activity.  This seizure activity is very unusual, especially not showing spike and wave activity, but there is real electrical changes corresponding to the clinical activity.  There is no evidence of hypoxia or anoxia to the cortex.  There is no slow activity on the posterior region, but this generalizes.  This CCTV correlates with seizure activity originating from the left occipital lobe.  From the left occipital lobe it spreads tot he left posterior temporal lobe and then to the whole left hemisphere, and at the end spreads to both hemispheres.”  Focal seizure, probably developing complex partial seizures.  Focial seizure disorder, occipital lobe origin.  
11-21-96         Infected spine hardware.  Admission 11/21, discharge 11/27/96.  Cultures grew coagulase-positive staphylococcus.  Five day IV Kefzol and Cefadroxil for 3 weeks.