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A Case of Hemiparesis

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.

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A Case of Hemiparesis

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  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 Hemiplegiasecondary to R frontoparietalmass 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 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: coughwith 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 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)

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