The latest...

The doctors are still working to pinpoint a diagnosis for Sara's condition. All of Sara's tests came back with good news yesterday. There were no clots in her extremities and no hole in her heart. The doctors are having a difficult time diagnosing Sara's condition because all of her tests appear to be normal. The symptoms were pointing to eclampsia, but they are not considering Sara's blood pressure to be excessive. The majority of the team of doctors working the case think she has "post-partum angiopathy." PRES, RPLS, and post-partum angiopathy are all very similar in that there is swelling/seeping of the blood vessels in the brain.

The radiologists seem to think that they have spotted a clot, which would point towards a stroke. This afternoon they are going to do an MRA. This is a test of the arteries going into the brain to look for a clot (done in the MRI machine). There were no clots in the veins, but they want to rule out clots completely.

After a long discussion with the lead doctor on the case, we discussed lots of "risk vs. reward" considerations with the tests. He said all of the tests they have done are "minimally invasive" and carry a small amount of risk (i.e. the rewards outweigh the risk). Once the tests begin to get risky, we have to decide on whether the risk is work it. For example, the neurologists think that she might have some excessive cranial pressure, so they want to drill into her skull and place a pressure transducer on her brain. This is extremely invasive and carries a large amount of risk. (I just got off the phone with the Neurosurgeon at Wilford Hall and he does not think that there is any benefit to placing the transducer in her brain).

The problem that Sara has is that none of her labs and blood work show a glaring problem. If some of her counts or numbers were completely out of bounds, it would be a simple problem to diagnose. All her tests have been right where they should be for a healthy person. I got a little frustrated with the doctors yesterday and I asked, "How long are you going to continue to run tests before starting treatment?" He told me he is reaching his "comfort level" and is ready to start treating the most likely case. The problem is that the treatment options for stroke vs. PRES are completely different and treating the wrong one could have devastating results.

The plan right now is to stop the sedatives tomorrow and wake her up. Everybody wants to see if she is able to respond and move all of her extremities. In her current sedated state, no harm is being done. The neurologists explained that her brain is currently on standby. The concern is that if she starts to have another seizure, there could be more damage to her brain. If she seizes, they will put her "back under" and let the brain rest for 48 hours and try to wake her up again.

I will update tomorrow regarding Sara's wake-up. Pray that there are no seizures and that there has been no permanent brain damage.