Apple Children Hospital Chandkheda

08/03/2026

25/02/2026

History. Vitals. Evidence: A PICU Reminder

PICU — The Ultimate Battle of Time and Mind

The PICU is not just a unit.
It is a battlefield.

Not only against disease — but against time, assumptions, and cognitive shortcuts.

A 12-year-old boy arrived after moving through multiple rural healthcare centers. By the time he reached us, one devastating symptom defined him:

Blindness.

His referral papers carried a firm diagnosis: viral encephalitis.
Treatment had already begun accordingly.

But something did not fit.

There was no fever.
There was no altered sensorium typical of encephalitis early on.
Instead, there was a 10-day history of persistent headache.

Blindness without fever?
Unusual for viral encephalitis.

That was the first pause.

---

The Turning Point: Vitals

In the rush of critical care, sophisticated investigations often take center stage.

But the simplest tool changed everything.

Blood pressure was checked immediately.

It was severely elevated.

Hypertension in a 12-year-old with headache and sudden visual loss.

Now the pieces began rearranging themselves.

An urgent MRI confirmed the suspicion:

Posterior Reversible Encephalopathy Syndrome (PRES)

Not viral encephalitis.

Not infection.

A hypertensive emergency affecting the brain.

---

The Simplicity of the Cure

No antivirals.

No escalation of empirical therapy.

Just controlled, careful blood pressure management.

Gradually, vision improved.
Neurological status stabilized.

The “encephalitis” reversed.

Because it was never encephalitis.

---

But Why the Hypertension?

The next question mattered just as much.

Urine examination was surprisingly normal.

But C3 levels were low.

The underlying cause revealed itself:

Poststreptococcal glomerulonephritis (PSGN)

A renal trigger.
A hypertensive crisis.
A neurological manifestation.

A chain reaction — missed because the first label stuck too firmly.

---

The Real Diagnosis

The real diagnosis was not just PRES.

It was premature closure.

---

Take-Home Message

1️⃣ History. History. History.

Ten days of headache was the clue.

2️⃣ Examine vital signs yourself.

Blood pressure is not optional.

3️⃣ When the picture doesn’t fit — stop.

Do not go blindly with a written diagnosis.
Look for supporting evidence.

In the PICU, every minute matters.
But so does every thought.

Because sometimes, saving vision…
is as simple as checking a blood pressure

21/03/2024

18 months old child now

*Story of faith and dedication*

He had intubation at birth due to MAS , was on ventilator for 7days, discharged successfully but again developed respiratory failure and intubated for another 7 days.and then within 2 months same story repeated thrice

At 2months Came *Apple children hospital* - for impending respiratory failure and requirements of respiratory support.

*Reason for recurrent respiratory failure ??*

Relative were councelled. Keeping faith on us they have agreed. A flexible
bronchoscopy in 3 kg infant with impending respiratory failure is not a joke. But superbly performed by *Dr Parag Dagli* and - sub glottic tracheal stenosis was identified.
Again relatives are counselled.
Highly Dedicated mother showed great willingness and courage. Tracheotomy was done.
Child has improved And improve and discharged with tracheostomy care .
For 18 months mother took care of her child continuously and tirelessly. Because of her child thrives normally

Fast forward to grown up 18 months....lasser surgery done and gradually tube removed
Now grown up normal healthy kid

We are fortunate that relatives kept faith on us in difficult time

*Apple children hospital*
🍏 team

23/01/2024

23/10/2023

18/10/2023

Delivery at 29 weeks( 6 and half months) ... birth weight only 1 kg ...today 9 months and turned so cute after the amazing fight for life at birth....the trust continues...team 🍏 team work...

07/10/2023

15/08/2023