1. A Case of Hemiparesis

2. 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

3. 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

4. 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

5. 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

6. History of Present Illness
At Rehab Ward
9 days at Rehab

7. 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)

8. 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

9. 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

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

11. OB-Gyn History
G3P3(0301)
Menopause at 55

12. 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

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

14. 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

15. 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)