Mek kenuan
B760742
4u

56yo siamese lady
Underlying hpt

P/w mid back pain 10months
More over left side
Throbing in nature
No radiation of pain,no known aggravting factors
Partailly relieved with meds

Subsequently having lower limb numbness, feeling thick at sole of foot for 6 months
Numbness was progressively worsening and asceding up to hip
Pt started having ascending weakness since nov 2020. Initially used walking stick then walking frame. Within one month pt was wheelchair bound.(dec 2020)

Pt seeked attention in hrpz and given appt for mri in feb 2021. However in view of worsening weakness pt came to husm

Futher questioning, denied bowel or urinary sx. No fever or constitutional sx. No history sugesstive of other primary malignancy.

O/e vitals normal
systemic examination unremarkable
Lungs clear, pa soft
No lymphadenopathy, no breast lump

Hmf intact
UL examination normal

LL hypotonia and hyporeflexia bilaterally with absent plantar

Sensation reduced from T10-t12. L1 downward s absent sensation all modalities

Mri showed intadural extramedullary lesion at t8-t9 level extending onto left exit foramina (dumbel shape)

Imp: t8-t9 spinal schwanoma
Ddx neurofibroma, dural mets, meningioma

Plan
Take over to 3u
Steroids
For laminectomy kiv left facetectomy and posterior instrumentation + tumor excision