Medical Timeline
Complete chronological history 2015–2026
Road Traffic Accident
GCS 7/15 (severe TBI). Subarachnoid hemorrhage (right temporal). Left subdural. Chest contusion. Right radius/ulnar fracture.
ICU & Coma (3 weeks)
Coma started immediately after accident. ICU stay was 3 weeks. Mild physio sessions during ICU stay. 3 tonic-clonic seizures on consecutive days ~3 weeks in — phenytoin and tegretol added.
First Post-Traumatic Seizures (ICU)
3 tonic-clonic seizures on 3 consecutive days in ICU, ~3 weeks post-accident. Phenytoin and Tegretol started.
Transfer to Apollo Rehab, Hyderabad, India
After 3-week ICU stay, transferred to Apollo Rehabilitation Hospital in Hyderabad, India. Woke up from coma on 2nd day after arrival.
Apollo Rehabilitation — 9 Months
Intensive rehabilitation at Apollo Hospital, Hyderabad, India for 9 months. Woke from coma on 2nd day after arrival. Therapies included: physiotherapy, occupational therapy, electro-stimulation, and swallowing therapy.
Follow-up MRI
Periventricular leukomalacia. White matter and gliotic changes. Pons/left medulla ischemic foci.
Discharge from Apollo Rehab
Completed 9-month rehabilitation program at Apollo Hospital, Hyderabad, India.
Continental Hospital, Hyderabad, India
Diffuse Axonal Injury confirmed. Awoke from coma 3 days after arrival. Power improved to Grade 3/5. Decreased spasticity. Improved verbalization.
Video EEG
Dominant beta activity (18-22 Hz). Theta slowing (5-6 Hz) over left temporal. Abnormal EEG with focal slowing.
BERA Hearing Test
Right: moderately severe to severe loss. Left: severe to profound loss. Amplification recommended.
Royal Care Medical Report
Pre-transfer evaluation at Royal Care International Hospital, Khartoum. GCS 11/15, semi-conscious. On triple AED therapy + trimethoprim for UTI.
Continental Hospital Admission (Rehab)
Admitted to Continental Hospitals, Hyderabad for neurorehabilitation. Spastic quadriplegia. Grade 0/5 power lower limbs. UTI with Enterococci treated.
Video EEG
Abnormal EEG showing left temporal focal slowing. No spikes or sharp waves.
BERA Audiology Test
Right ear: moderately severe to severe hearing loss. Left ear: severe to profound hearing loss. Amplification recommended.
Continental Hospital Discharge
Remarkable improvement: verbalizing, obeying commands, power improved to 3/5, decreased spasticity. Discharged on Keppra, Depakine, Liofen.
ApoKOS Rehabilitation, India
Completed physical therapy and occupational therapy. Medically stable, fit for air travel.
ApoKOS Rehab — Fit to Fly
Completed rehabilitation at ApoKOS (Apollo). Medically stable and fit to travel by air. Needs wheelchair for boarding.
MRI Brain & Cervical Spine
Bilateral frontoparietal lacunar infarcts. Subcortical arteriosclerotic leukoencephalopathy. C3-7 disc bulges. No acute ischemia.
CT and MRI Brain
Bilateral ventricular dilatation. Thinned corpus callosum. Reduced brainstem volume. Bilateral microbleeds (post-traumatic).
Breast Cancer — Full Treatment Course
Diagnosis: Invasive Lobular Carcinoma (ILC) of left breast. Treatment: (1) Jun-Sep 2022: Neoadjuvant Paclitaxel (Taxol) chemotherapy — 130mg per session with Granisetron + Dexamethasone premedication. (2) ~Oct 2022: Left Modified Radical Mastectomy (MRM) with Level I & II lymph node dissection — Dr. Ahmed Farahat, National Cancer Institute, Cairo University. History of 2015 accident causing fat necrosis noted. (3) Dec 2022 - Jan 2023: Adjuvant Stereotactic Rapid Arc radiotherapy to left chest wall — 28.5 Gy in 5 fractions over 5 weeks at Dar Al Fouad Hospital (in collaboration with Cleveland Clinic). Dr. Hussien Metwally (Oncology) + Dr. Sarah Hazem Hussein (Radiotherapy). Referring oncologist: Dr. Emad Mohsen Barsoum. Outcome: Cancer-free. Good tolerance throughout.
CBC — ANC 4.958 (Normal Pre-Tegretol Baseline)
Complete blood picture at Al Salam Hospital. KEY FINDING: ANC was 4.958 (completely normal, ref 2.0-7.0) BEFORE Tegretol was started. Current ANC 0.7-0.8 — this baseline proves the neutropenia is almost certainly carbamazepine-induced. WBC 6.7 (normal). Hb 11.7 (mild anaemia). Platelets 171 (normal). Ref by Prof. Emad Mohsen Barsoum.
Eye Examination — Almouneer Clinic
Visual acuity: Right eye (OD) 0.9, Left eye (OS) 0.6 P. No corrective lenses needed. Sphere/Cylinder both 0.00 for both eyes. IPD Far: 67. Almouneer Diabetes & Eye Care clinic.
Breast Cancer — Full Treatment Course
Diagnosis: Invasive Lobular Carcinoma (ILC) of left breast. Treatment: (1) Jun-Sep 2022: Neoadjuvant Paclitaxel (Taxol) chemotherapy — 130mg per session with Granisetron + Dexamethasone premedication. (2) ~Oct 2022: Left Modified Radical Mastectomy (MRM) with Level I & II lymph node dissection — Dr. Ahmed Farahat, National Cancer Institute, Cairo University. History of 2015 accident causing fat necrosis noted. (3) Dec 2022 - Jan 2023: Adjuvant Stereotactic Rapid Arc radiotherapy to left chest wall — 28.5 Gy in 5 fractions over 5 weeks at Dar Al Fouad Hospital (in collaboration with Cleveland Clinic). Dr. Hussien Metwally (Oncology) + Dr. Sarah Hazem Hussein (Radiotherapy). Referring oncologist: Dr. Emad Mohsen Barsoum. Outcome: Cancer-free. Good tolerance throughout.
Chemotherapy Session — Paclitaxel (Taxol)
Neoadjuvant Paclitaxel chemotherapy. Pharmacy receipt: Paclitaxel 30mg vial + 100mg vial (total 130mg). Premedications: Granisetron 3mg (anti-nausea), Dexamethasone, Avil (antihistamine). Alomaraa Pharmacy, total 1751 EGP.
Surgical Referral — Left Mastectomy (MRM)
Referral by Dr. Ahmed Farahat (Associate Professor of Surgery & Surgical Oncology, National Cancer Institute, Cairo University). 57yo female with left breast Invasive Lobular Carcinoma (ILC), status post neoadjuvant Taxol. History of 2015 RTA causing multiple areas of fat necrosis. Specimen: Left Modified Radical Mastectomy (MRM) including Level I & II lymph nodes. Referred to Dr. Elia for surgery.
Breast Cancer — Full Treatment Course
Diagnosis: Invasive Lobular Carcinoma (ILC) of left breast. Treatment: (1) Jun-Sep 2022: Neoadjuvant Paclitaxel (Taxol) chemotherapy — 130mg per session with Granisetron + Dexamethasone premedication. (2) ~Oct 2022: Left Modified Radical Mastectomy (MRM) with Level I & II lymph node dissection — Dr. Ahmed Farahat, National Cancer Institute, Cairo University. History of 2015 accident causing fat necrosis noted. (3) Dec 2022 - Jan 2023: Adjuvant Stereotactic Rapid Arc radiotherapy to left chest wall — 28.5 Gy in 5 fractions over 5 weeks at Dar Al Fouad Hospital (in collaboration with Cleveland Clinic). Dr. Hussien Metwally (Oncology) + Dr. Sarah Hazem Hussein (Radiotherapy). Referring oncologist: Dr. Emad Mohsen Barsoum. Outcome: Cancer-free. Good tolerance throughout.
Breast Cancer — Full Treatment Course
Diagnosis: Invasive Lobular Carcinoma (ILC) of left breast. Treatment: (1) Jun-Sep 2022: Neoadjuvant Paclitaxel (Taxol) chemotherapy — 130mg per session with Granisetron + Dexamethasone premedication. (2) ~Oct 2022: Left Modified Radical Mastectomy (MRM) with Level I & II lymph node dissection — Dr. Ahmed Farahat, National Cancer Institute, Cairo University. History of 2015 accident causing fat necrosis noted. (3) Dec 2022 - Jan 2023: Adjuvant Stereotactic Rapid Arc radiotherapy to left chest wall — 28.5 Gy in 5 fractions over 5 weeks at Dar Al Fouad Hospital (in collaboration with Cleveland Clinic). Dr. Hussien Metwally (Oncology) + Dr. Sarah Hazem Hussein (Radiotherapy). Referring oncologist: Dr. Emad Mohsen Barsoum. Outcome: Cancer-free. Good tolerance throughout.
Radiotherapy — Stereotactic Rapid Arc (Dar Al Fouad)
Adjuvant Stereotactic Rapid Arc radiotherapy to left chest wall. Dose: 28.5 Gy in 5 fractions over 5 weeks (27/12/2022 to 24/01/2023). KV & CBCT matching daily for treatment verification. Ended with good tolerance. Dar Al Fouad Hospital (in collaboration with Cleveland Clinic). Dr. Hussien Metwally (Oncology Consultant, ID 91150) + Dr. Sarah Hazem Hussein (Radiotherapy Specialist, ID 91626). Planning Rapid Arc: 7,920 EGP + Session Stereotactic: 4,840 EGP = 12,760 EGP total.
Cardiac Echocardiogram — Pre-Radiation Workup
Pre-radiation cardiac assessment. Ejection fraction 65% (normal). Diastolic dysfunction grade I. Normal LV dimensions, no masses, no effusion. Dr. Mohamed Mohsen, referred by Prof. Emad Mohsen Barsoom.
Liver & Kidney Function — Cholesterol 295 (HIGH)
Medpark Labs. Liver enzymes normal (AST 14, ALT 17). Bilirubin normal. Kidney function normal (Urea 25, Creatinine 0.6). Cholesterol significantly elevated at 295 mg/dL (ref <200, High >=240). Uric Acid 2.9 (normal).
SEVERE Seizure — Baclofen Withdrawal
Severe seizure after baclofen was stopped cold turkey (junior doctor recommendation). Lost partial sight for 2 days. Hospitalized 1 week. Keppra and Tegretol added — escalated from Depakine monotherapy to triple AED therapy. Baclofen restarted after hospitalization.
Severe Seizure — Baclofen Withdrawal
Patient was seizure-free approximately 9 years (Mar 2015 – Feb 2024) on Depakine monotherapy. The Feb 2024 event was precipitated by iatrogenic baclofen withdrawal (cold turkey, advised by local junior doctor), not spontaneous epilepsy worsening. Lost partial sight for 2 days, hospitalized 1 week. Led to triple AED therapy (Depakine + Keppra + Tegretol).
CBC - ANC 0.7
Moderate neutropenia (ANC 0.7). Leucopenia. First documentation of carbamazepine-induced neutropenia.
Breakthrough Seizure (Morning)
Morning seizure on triple AED therapy. No clear trigger. No medication changes.
CBC - ANC Improved to 1.5
ANC improved to 1.5 (mild neutropenia). Mild thrombocytopenia (platelets 139).
UTI — ESBL E.coli (1st Episode)
First documented ESBL E.coli UTI. Pus cells 70-80/HPF. Multi-drug resistant — only carbapenems, amikacin, fosfomycin, nitrofurantoin effective.
UTI — ESBL E.coli (2nd Episode)
Recurrent ESBL E.coli UTI. Pus cells 60-70/HPF. Similar resistance pattern.
UTI — ESBL E.coli (3rd Episode)
Third ESBL E.coli UTI. Pus cells 70-80/HPF. Resistance evolved: now resistant to ALL fluoroquinolones.
Nail Culture — Aspergillus niger
Aspergillus niger identified from nail culture. Sensitive to itraconazole, voriconazole, ketoconazole.
UTI — Pseudomonas (Organism Shift!)
ORGANISM CHANGE: Pseudomonas replaced E.coli. CRP 59.1 (12x upper limit). Active systemic infection with concurrent neutropenia (ANC 1.5).
BP Drop During Physiotherapy — 95/55 mmHg
During standing exercises in physio, patient suddenly could not hold herself upright. BP measured at 95/55 mmHg (baseline ~90-100/60-65). Context: Morning drugs taken with yogurt, followed by breakfast (fool + cheese), avocado juice with creatine 5g, blueberries, then physio. Likely multifactorial orthostatic hypotension: Baclofen (vasodilatory, taken 8 AM), residual Quetiapine (alpha-1 blocker, taken 10 PM prior night), postprandial blood redistribution, CBZ-related SIADH/hyponatremia, and TBI-related autonomic dysfunction. Not the first occurrence during physio — recurring pattern. Intervention: Session stopped, patient seated, fluids given.
Comprehensive Lab Panel
ANC back to 0.7. Mg 1.7 (low). CEA 6.3 (elevated). Cr 0.57 (sarcopenia). Ammonia 0.86 (borderline). CysC 0.88 (normal kidneys).
Seizure During Lung Infection
Seizure during active lung infection (fever lowers seizure threshold). VPA sub-therapeutic (23.1, tapering). ANC 0.7. No medication changes.
Imaging: Mammography + Ultrasound + CXR
BIRADS 3 (probably benign). Abdomen/pelvis normal. CXR clear.
Supplements Started
Creatine 5g/day + WPI 25g/day + Lactoferrin 100mg + B6 50-100mg. Week 1 of introduction protocol.
Sputum Culture — Carbapenem-Resistant Pseudomonas
Pseudomonas in sputum RESISTANT to carbapenems. Only sensitive to piperacillin and fluoroquinolones. Extremely limited treatment options.
Breast Screening — BIRADS 3 Stable
Mammography + US: BIRADS 3 (stable from 2025). Probably benign fat necrosis post-mastectomy. Half-annual screening.
Sputum Culture — Commensals Only (Cleared!)
Sputum C/S (Alfa Labs): Growth of commensals only. No pathogenic bacteria isolated. ZN negative (no TB). Major improvement from Jan 2026 carbapenem-resistant Pseudomonas.