Name: Suriani bt Sulaiman 
IC No: 861115465452
RN: 20548

Underlying GERD (Under SOPD follow up)
-On Tab pantoprazole

Initially went to Hospital Tanah Merah (HTM) ED on 20/1/2021 due to fitting at home around 11.30 pm. Patient was ready to sleep at that time. Noticed by husband patient having tonic movement of upper limb, drooling of saliva and uprolling of eyeball. At ED HTM, IV KCL 2g/2H and IV MgSO4 1 ampule/H given. Patient the request for AOR discharge.

Second visit to ED HTM today, patient had fitting episode  x3 at home, at 9.15am, 9.30am,10.15am. Pre icatl, patient just relaxing and talking to family members.Patient had the same presentation like the first fit. In addition to that, patient had facial asymmetry. Duration is less than 1 minute and it aborted spontenously. 

In ward today at about 3pm, patient had another episode of fitting which lasted less than 1 minute. Post ictal, patient complaints of lethargy and had brief slurring of speech.

Otherwise, she denied fever. 
-No headache
-No body weakness
-no UTI or URTI symptoms

At ED, patient GCS full. BP slightly high 152/78, pulse rate 123,RR 23, T 38, Spo2 100% under room air. 

Pt was given T PCM 1g, IV KH2PO4 and IV Drip. 

On examination, Lungs is clear with equal air entry. CVS DRNM, P/A Soft and non tender. CNS Examination, Tone is normal for both Left and Right Upper and Lower Limb, Power is 5/5 for both Left and Right Upper and Lower Limb, Reflexes are normal,no clonus and Babinski is downgoing.Cerebellar sign is negative, gait is normal.

Blood investigation as following:
Hb 11.7/ WBC 18/PLT 295 /HCT 38
Urea 3.05/Na 137 /K 3.5/Creat 74
Protein 79/Alb 42/ Total Bili 7.53/ALP 89/ALT 23/AST 23
Ca 2.12/po4 0.76/Mg 1.29

CT brain 21/1) Impression: Features are of intra axial tumour at left frontal lobe.

Heterogenously enhancing intra-axial mass at left frontal lobe with multiple calficiation measuring 1.7x1.7x1.8cm
minimal perilesional oedema.


Anti-epileptic, phenytoin
MRI / MRA / MRV 
Tro AVM, Meningioma, Oligodendroglioma
Tca after MRI
Differential diagnosis: Astrocytoma, Oligodendroglioma