Case presentation Int:雲智謙 99.08.25

P’t profile Name:許信裕 Gender：M Age：50 Chart No. :26243378 Date of admission:2010/08/22

Chief complaint right facial numbness for half a year

Present illness The 50 y/o male had hypertension with medical control. He complained of right facial numbness half a year ago initially, then the right tongue involved. He denied faical palsy, drooling, easily choking. He also had tinnitus then. He had double vision about one and half month ago, after the treatment in 阮綜合 hospital. The phenomenon of diplopia disappeared, but the numbness of right lower cheek and chin still persisted.

Present illness He also complained of mild gait imbalance sometimes. He denied memory loss, headache, urinary incontinence. Because of above reason, he was arranged brain MRI and positive finding. Then he was admitted to our ward further management.

Past history DM: denied HTN: with medication control Liver disease: denied CVA CAD Asthma: denied Other systemic disease: denied Hospitalization history: denied

PE Consiousness: clear GCS: E4 V5 M6 Vital sign:BP: 124/73 mmHg, PR:81 bpm, RR:19 cpm, BT:36.8 ℃ Sclera: not icteria, conjuctiva: not pail Neck: Supple, Lymphadenopathy(-) Chest: Inspection: symmetrical expansion Auscultation: Bil. clear breathing sound, crackles(-) , regular heart sound, murmur(-) Abdomen: Extremities: pitting edema(-), ecchymosis(-), freely movable

NE – high cortical function JOMAC Judgement: fair Orientation: to 人 : fair to 時 : fair to 地 : fair Speech: dysarthria(-) Language: Fluency: ok, Repetition:ok, Comprehension:ok, Naming:ok

NE – cranial nerves I: smell: not test II: VA: ok VF: ok II+III: light reflex R't / L't ( +/ + ) ( 3.0 mm/ 3.0 mm) III+IV+VI: EOM is intact 0 0 0 0 0─┼x┼─0 0─┼x┼─0 nystagmus: nil diplopia: for ten days, about one and half ago ptosis: nil V: masseter: powerful facial sensation: numbness at rigth V3 corneal reflex: R/L:(+/+) V+VII: corneal reflex: fair

NE- cranial nerves VII: no facial palsy VIII: tinnitus IX+X: uvula deviation: central position gag reflex: fair XI: trapezius: fair SCM: fair XII: tongue deviation: no deviation

NE – muscle tones and powers Muscle tone: normal Muscle power Right Left Upper extremities 5 5 Lower extremities 5 5 Lhermitte sign(-), Hoffmann refelx(-/-) Babinski sign : plantar-flex/ plantar-flex Drop foot:(-)

NE - DTR DTR right left biceps ++ ++ triceps ++ ++ brachilis ++ ++ knee +++ +++ achillis +++ +++ Barbinski sign: dorsal- flex dorsal-flex

NE – sensory function pin-prick: bilateral lower limbs numbness light touch: bilateral lower limbs numbness vibration: bilateral lower limbs numbness position sense: bilateral poor

NE – COORDINATION AND GAIT: Coordination: FNF: no dysmetria HKS:no dysmetria tendem Gait: inbalanced, romberg test: normal SENSORY FUNCTION pin-prick, light touch: 2+

Lab data

Available image MR

Different diagnosis brain tumor, suspect meningioma hydrocephalus