A Case of Hemiparesis.

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Presentation transcript:

A Case of Hemiparesis

General Data M. E., 62/F Right-handed Separated with one son Admission from NSSCU s/p Right Parietal Craniotomy Left Hemiplegia secondary to R frontoparietal mass probably meningioma

History of Present Illness 1 yr PTA Gradual weakening of left upper and lower extremity No loss of consciousness, no fever, no headache/vomiting/BOV, no sensory deficits No trauma Don Santiago Hospital: CT scan revealed R frontoparietal mass tumor  for Surgery

History of Present Illness 1 yr PTA Deferred Surgery because of financial constraints Take home meds: Kepra, Simvastatin, Vasalat L Hemiparesis worsened to L Hemiplegia Regularly consults at DSH ADLs dependent

History of Present Illness 1 mo PTA Decided to proceed with surgery hence admission at PGH-NSS (May 15, 2009) Right Parietal Craniotomy, excision of tumor Dx: Right frontoparietal convexity meningioma Transferred to Rehab Ward

History of Present Illness At Rehab Ward 9 days at Rehab

Review of Systems General HEENT Chest, Heart, Lungs Abdomen Negative for: fever, weight loss, malaise, anorexia, vomiting HEENT Negative for: headache, BOV, loss of hearing, vertigo, dysphagia, dysphonia Positive for: coryza, 3 days Chest, Heart, Lungs Negative for: dyspnea, chest pain, palpitations, orthopnea, PND Positive for: cough with yellow sputum, 3 days Abdomen Negative for: abdominal pain, diarrhea, acholic stool, hematemesis, loss of sphinteric tone, bowel incontinence Positive for : constipation (after the surgery)

Review of Systems Urinary System MSK Nervous Negative for: dysuria, hematuria MSK Negative for: pain, swelling, redness, warmth Nervous Negative for: behavioral change, dysphagia, dizziness, numbness, paresthesia

Past Medical History (+) HPN (2008), Dyslipidemia (2009) (-) DM, BA, allergy, PTB, HD s/p R parietal craniotomy No other hospitalizations and surgeries No history of exposure to radiation

Family Medical History (+) DM (brother), HPN (sister), HD (mom) (-) BA, PTB, stroke, CA

OB-Gyn History G3P3(0301) Menopause at 55

Personal and Social History Lives with her 28-yr old son in a 2-storey house, sleeps in the first floor Bathroom is 6 steps away from sleeping area Nonsmoker, nonalcoholic College Undergraduate Owns a sari-sari store Not active in any community or church orgs

Goals of the Patient To ambulate To do ADLs independently, if not full recovery

Physical Examination Patient is awake, cooperative, conscious, coherent, non-ambulatory, NICRD BP 125/70 HR 80 RR 20 T 36.4 HEENT: ecchymoses (posterior to right ear and scalp), 30 cm surgical wound with staples at the temporoparietal area, PC, AS, (-) NVE/CLAD Chest: AP, ECE, CBS, (-) rales/wheezes, (-) thrills/heaves/murmur, NRRR, DHS

Physical Examination Abdomen: flat, NABS, soft, (-) masses or tenderness Extremities: dry scaly skin, pail nailbeds, (+) clubbing, (-) cyanosis/edema, muscle atrophy (bilateral upper and lower extremities)