Dyslexia appears suddenly in this patient. The progress of the illness can be changed. Further possible treatments are available at www.quizdoc.com

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Female            Six and a half years old 
  

This little girl has presented with acute dyslexia. This is an episode of deep brain damage due to Paill Spectrum infection. There is a background of wheat (gluten) allergy. The condition improved markedly on antibiotics and nutritional therapy.

 10th December 2001:
Presenting complaint is severe eczema.
This involves the back, neck, knees, arms and front of the mid-arm at
elbow crease level.

Treatment
Cefaclor (broad spectrum antibiotic) and
Elocon Cream (a very powerful steroid cream).

.11Th   December 2001
Allergy Skin Test Performed Today:
Dust mite: no allergy (negative)               
Cockroach: no allergy (negative)            
Cat: no allergy (negative)

Grass mix: A Very Positive result (scores +2) with hives-like swelling on the skin (wheal)
Bermuda, rye and couch are the main allergens in the grass mix.
Tree mix: no allergy (negative)
(Main allergens in this mix are :
wattle, eucalyptus, willow, melaleuca, Casuarina)Food Allergens are all negative : no allergy detected.
(Milk, Peanut, Wheat, Baker’s yeast, Oranges).
Mould: no allergy (negative)

Basically a well child: only occasionally requiring treatment.
Seen only for one episode of a cold with perhaps some sinusitis and for one routine vaccination till this year.

The test has confirmed that the child does indeed have some important and common allergies.

.18th September 2002
Mother complains the child is always tired.
In bed by 6pm and wakes at 6-6.30amCranky

Drinking lots
There is a family history of non-insulin dependent diabetes.
She has always been a sleeper and cries easily.

Investigations:
Thyroid tests : reported normal, (T4 and TSH)
Serum Vitamin B12 is reported as normal
Full Blood Count: reported as normal. There is a slightly high eosinophil white blood cell count, but this is essentially normal.

Iron Levels : Normal

Liver, kidney functions and blood sugar are all reported normal. 
Cholesterol 3.9 (Reference Range 2.5-4.5)

Antigliaden IgG Antibody 2.62 (Reference Range <1.00)
Antigliaden IgA Antibody 0.81 (Reference Range <1.00)

Weight: 25kg:          90%
(She is more weighty than 90% of children, exactly her age).

Height:123cm:        97%
(She is taller than 97% of children, exactly her age).

It was decided in consultation with the parents that a wheat free diet may benefit the child. It was decided not to do an endoscopy.
Over the next few months: mother says her daughter has benefited to some extent from a wheat free diet.

26th July 2003
Today the child presented with a facial rash: around the eyes and around the mouth. The rash also affected neck creases and elbow creases.
The appearance is suggestive of an allergic (atopic) rash.
The child has been itching and complaining of stinging.

Mother proudly says the child is top of her class, the brightest child in her class and the best speller in her class. Her spelling is always 100% right and she reads very well.Recently there have been some hysterical screaming events at her sister. Her little sister had ripped a picture and the child had “lost it”. The behaviour was very atypical for the child.She still sleeps 7pm-6am: i.e. 11 hours
When she wakes up, she is OK for about 10 minutes then her moods are fragile.
The mother’s impression was that there was a faint consistent personality change.

Mother said she was often tired. There was no bruising.

Mum says: "The child was incredibly clumsy. She was not very coordinated and tended to trip a lot." Mum says she even runs clumsy, though she has been looking better with time this year.

Mum mentions that the child complains that her legs are sore; she cannot stand, as she is too tired and can occasionally cry with sore legs.

On examination:

There is an impression of slightly “flat” appearance
She really does not look very well, but there is nothing specifically wrong with her.
Chest is OK, very mild red throat noted

In the number recall test, the doctor says a number and the child is asked to repeat the number by writing the number down on a piece of paper.

Dr. says: 4071                       Answer: 2126                       

Dr. says: 3964                       Answer: 3968                       

Dr. says: 4037                       Answer: 4837                    
Dr. says: 9286                       Answer: 9268                       

This is a highly significant result and shows some characteristic errors that are typical of this child's condition. I believe it is not possible for a child with this learning problem to be the best speller in the class. This problem therefore has appeared to have developed only very recently.

Pulse Rate 60 regular (normal).

Cervical Lymph Nodes: A little enlarged                 
Faintly red throat only.

Treatment :   XXXX for three days : see final case notes on our CD Book.

                        XXXX course: see final case notes on our CD Book.

29th July, 2003
Child appears slightly more spontaneous

Dr. says: 3821                       Answer:: 3821                       

Dr. says: 4071                      Answer: 4070                       

Dr. says: 3946                     Answer: 3964            

Dr. says: 4037                     Answer: 4037                       

Dr. says: 9286                    Answer: 9286                       

Impression : Very few mistakes and much better performance compared to the previous few days. The child looks like she is doing well. On the previous test , the child looked distressed doing the test.
The weird extra number error is gone now. (I have not included these examples , to keep the case simple and readable. The full notes are of course available on our CD Book).

Investigations :
A test result pattern on the blood test suggests that the child has the PaillSpectrum Syndrome.

.7th October, 2003
The child has definitely picked up. Not as tired. Not as moody
Everyday crying and upsets has stopped and largely happens only if she eats wheat.
Even if she has lollies with a bit of wheat, she is unwell for days.
A biscuit eaten will trigger a rash appearing under the eyes and the facial skin will peel.

The child still says she has pains in the stomach daily.
Even though she has more energy, she tires very easily.

Mother mentions that in the last few days at school , the child fell over three times and seems to be quite clumsy.
Aggression seems to have faded and is back to the usual fighting with her sister.
Teacher says I am very happy with her reading. She makes spelling mistakes, but these are felt to be usual for a kid of her age.
There are many fewer complaints of pain in the legs, but the complaints still occur frequently.

On examination:
She really looks a  bit brighter and smiles a bit more.