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University of the East Ramon Magsaysay Memorial Medical Center

University of the East Ramon Magsaysay Memorial Medical Center. Department of Neurosciences. Aclan , Beltran Alexis Agbanlog , Nadinne Agoncillo , Karen Elouie Ang Ping, Krista Claudine Ascue , Ronald Alvin. Identifying Data.

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University of the East Ramon Magsaysay Memorial Medical Center

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  1. University of the East Ramon Magsaysay Memorial Medical Center Department of Neurosciences Aclan, Beltran Alexis Agbanlog, Nadinne Agoncillo, Karen Elouie Ang Ping, Krista Claudine Ascue, Ronald Alvin

  2. Identifying Data • C.B., 60 years old, Filipino male, Roman Catholic, born on June 27. • Currently resides at 1950 at Burgos, Pangasinan.

  3. History of Present Illness • 8 weeks PTA • Sudden onset of headache with no known predisposing factors • Described as light headedness and discomfort in the frontal area • 7 / 10 intensity • Occurred in the evening

  4. History of Present Illness • 8 weeks PTA • Sudden blurring of vision • Hazy but resolved after a few hours • Weakness of the middle and ring fingers

  5. History of Present Illness • 8 weeks PTA • Sought consult on the 3rd day of illness in a nearby hospital • Given an impression of mild stroke • No CT scan • Prescribed with Norvasc, Aspirin, and Statin

  6. History of Present Illness • 8 weeks PTA • Weakness was noted to be progressive • Whole left arm now affected • Accompanied by sudden onset of jerking movements • Lasted 1 minute • No intervention was done

  7. History of Present Illness • 7 weeks PTA • Consult was again sought • Unrecalled anti-convulsants were given • Relief was provided • Developed progressive dysphagia • Both solids and liquids • No alleviating and aggravating factors

  8. History of Present Illness • 2 weeks PTA • Weakness progressed to the left leg • Accompanied by jerking movements with a longer duration • Consult was sought • Underwent CT scan • Possible mass was detected • Given 2 anti-convulsants

  9. History of Present Illness • Patient was confined for 5 days until he was transferred to the UERMMMCI • Pertinent Positives: • (+) weight loss and weakness

  10. Past Medical History • Diagnosed with malaria on 1985

  11. Family History • Father died due to cancer of the lungs • Mother died due to CVA • 4th sibling died of stroke • 5th sibling died of cancer of the uterus

  12. Mental Status Examination Orientation: Patient is oriented to all spheres of orientation given minimal verbal cues and prompts; Able to give out personal information correctly Fund of Knowledge: Performed simple mathematical operations correctly

  13. Mental Status Examination Identifying common objects: Able to identify common objects presented such as pen, coin and keys Response to request: Able to perform simple familiar actions upon verbal request Gnostic functions: Intact

  14. Mental Status Examination Practic functions: intact; (-) ideational and ideamotor apraxia; knowledgeable in functions of common objects presented (e.g. brush and ballpen) Fluent speech Good insight and judgment

  15. Mental Status Examination (-) R to L disorientation, finger agnosia, agraphia, acalculia, good attention and concentration, intact immediate, recent and remote memory

  16. Cranial Nerve Examination CN I – intact, can identify test object CN II – intact visual acuity OD 20/200 OS 20/200, No visual field defect (+) direct pupillary reflex, (+) ROR, 4 mm pupil size CN III, IV, VI – brisk reaction to direct/consensual light; full EOMs, (-)Ptosis, primary gaze is midline

  17. Cranial NerveExamination CN V – Intact pain and light touch sensation on both left and right side Good masseter tone, (+) bilateral corneal reflex CN VII – left central facial palsy CN VIII – intact auditory acuity. Able to identify and laterilize stimuli

  18. Cranial Nerve Examination CN IX, X – uvula in midline, intact gag reflex, equal palatal rise CN XI – good right shoulder shrug, poor on left CNXII – tongue in midline with normal strength; able to push the tongue against the tongue depressor superiorly, anteriorly and on both sides; (-) atrophy and fasciculations

  19. Motor Strength Tests Right upper extremities: 5/5 Right lower extremities: 5/5 Left upper 2-3/5 Left lower 4/5

  20. Sensory Tests Right: 100% Left upper- 97% Left lower proximal 97% Distal: 85%

  21. Cerebellar Tests Able to perform finger to nose test with no over and under shooting noted

  22. Reflexes (-) Babinski and Clonus

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