Zailina Zakaria
54/F

U/L DM / Hpt (defaulted Rx 2 years)

P/w acute onset left sides weakness X 2/7
Weakness started yesterday at 6 am. Progressively worsening. Yesterday evening unable to ambulate or be functional.

A/w left sides facial asymmetry, left u/l weakness worse than left l/l

Otherwise no raised icp SX
No hearing impairment
No blurring of vision / diplopia
No bulbar SX
No fever
No trauma
No incontinence
No memory impairment.

ED did CT brain and referred in view of ?left cp angle tumour.


On my assessment

E4V5M6
Alert and orientated

BP 160/96
Pr 105
Afebrile
CBS 15.5


Systemic examination - unremarkable. 

Neurological examination

Higher mental function intact
No anosmia
Visual field normal
Pupil 3/3 reactive
Extraocular muscle intact - no diplopia
No facial numbness
Corneal reflex intact
Left upper motor neuron facial palsy
Hearing intact
Gag reflex present
Uvula central
Palette symmetrical
Tongue not deviated

Motor examination

Right  grossly normal. Babinski downgoing. Reflex 1+

Left
Tone - hypotonic
Reflex 1+

Power - u/l 2/5
L/l 3/
Babinski upgoing
Sensation intavtt

Cerebellar sign - unable to perform in view of left hemiparesis. Otherwise right cerebellar intact.


CT brain left cpa isodense mass with brain stem compression .
4th ventricle slightly compressed
Third ventricle and temporal horns dilated. No periventricular lucency
Basal cistern not effaced.
Cerebral atrophy
Right internal capsule hypodensity.
Multifocal infarct.


Imp: 1/ acute ischaemic stroke right MCA territory stroke - lacunar type.

Risk factor - uncontrolled hpt and DM

2/ left cp angle isodense mass.
Ddx - meningioma (incidental finding)


Took AOR discharge under Neuromed.

To be seen this week in our clinic.