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 Right Left Biceps Triceps
Triceps
Brachioradialis
Knee
Ankle
(-) Babinski and Clonus