Thursday, September 18, 2008

Pediatric Neurosurgery Anyone?

There is only so much one can learn in 3 years of a Family Practice Residency. Family Practice is one of the most challenging fields of medicine because it requires you to be competent in pediatrics, ob/gyn, adult medicine, and all subspecialities associated with them. Despite a great training experience at the Valley Baptist Family Practice Residency Program, pediatric neurosurgery wasn't something I got a lot of experience in. Today, was a day where I wished a knew a lot more about kids, neurosurgery, and radiology.
This kid is about 3-4 months old and has this misshapen head. I was quite surprised when I first looked at him. He has an obvious abnormality of the bones of the skull, but what exactly, I am not sure. I got this Xray and it shows overriding bones, but not sure if this is craniosynosytosis or something else. Craniosynosytosis is something I did learn about in residency and the only thing I would know to put in my differential. However, it is where the sutures are fused and so the brain doesn't have room to grow, but this doesn't quite seem like that. But then again, I can be wrong.
Another pt today was a baby of about 5 months old, who otherwise is developing normally, but has this swelling of the back of her head since birth. I had seen this previously in a 8 yo girl, or what looked similar. I knew enough to get a skull film to look for a defect and I tried to US it to see if I saw a defect or anything in it, but it seemed okay to me. However, this is only the 2nd time I have ever seen an ultrasound of an occiptal mass, so I am not sure I am highly qualified to say it looks okay. Again, my differential is not that large. (In medicine, the size of one's differential often shows how much one knows or doesn't know about a certain problem or condition. Obviously in these 2 instances, I know very little.) I have heard of an encephalocele, as we talked about it the 1st time I saw a pt with this, but that is about all I know it could be. An encephalocele is where some of the brain and meninges are herniated through the skull where a cranial meningocele is just the meninges. So it seems like it maybe just a cranial meningocele, but not really sure.
Cases like this are a great reminder of my own limitations. There is a lot I know about medicine, but SO MUCH more I don't know. I am thankful for my colleagues, both here and in the States, who continue to teach me, help me learn what I don't know, and answer all my questions. I am thankful for the Great Physician, who knows all our sicknesses and deformities and is able to heal us from it all by using doctors or not.