賴 OO I 賴 OO I 33 y/o, Female33 y/o, Female Denied any systemic diseaseDenied any systemic disease Chief complainment: Progressive ptosis of left eye for 3 monthsProgressive ptosis of left eye for 3 months

Present illness Intially,dizziness with headache without vertigo,nausea or vomiting was noted.Intially,dizziness with headache without vertigo,nausea or vomiting was noted. However, then progressive ptosis and double vision developed. Therefore,she had ever gone to 彰基 H. for help where MRI scan of brain showed faint contrast enhanced lesion over left midbain and thalamas. She was suggested with following up. However,the symptoms of ptosis got more severe and unstable gait was also noted due to mild weakness of right limbs. Then,she came to our NS OPD on for second opionHowever, then progressive ptosis and double vision developed. Therefore,she had ever gone to 彰基 H. for help where MRI scan of brain showed faint contrast enhanced lesion over left midbain and thalamas. She was suggested with following up. However,the symptoms of ptosis got more severe and unstable gait was also noted due to mild weakness of right limbs. Then,she came to our NS OPD on for second opion

P.E : totally ptosis of left eye and limited EOM to medial,upward and downward side. totally ptosis of left eye and limited EOM to medial,upward and downward side. Muscle power:R/L(4+/5). Muscle power:R/L(4+/5). Sensory impairment of right face. Sensory impairment of right face.

MRI of Brain One huge space occupied lesion in L't thalamus, midbrain andOne huge space occupied lesion in L't thalamus, midbrain and upper pons in long T2 signal and long T1 signal without upper pons in long T2 signal and long T1 signal without postcontrast enhancement, R/O low grade glioma postcontrast enhancement, R/O low grade glioma

手術日期及方法 Stereotaxic procedure-for biopsy (Leksell systom, SurgiPlan) Stereotaxic procedure-for biopsy (Leksell systom, SurgiPlan)

Biopsy pathology Anaplastic astrocytoma, WHO grade III.Anaplastic astrocytoma, WHO grade III.