Brain Tumor follow-up

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Returns for a ‍brain tumor follow-up

Last visit was ‍ ‍months ago



Head CT scan: ‍ ‍unremarkable

Head MRI: ‍ ‍unremarkable



Progress since last visit: ‍unchangedimproveddeterioratedvariableresolved



Updates on symptoms:

‍headache, ‍diffuse, ‍persistentintermittent, ‍pressurethrobbing, ‍mild

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍seizures

‍weakness in arms or legs

‍loss of sensation in arms or legs

‍visual disturbances

‍hearing loss

‍memory loss

‍personality changes

‍speech difficulties



Radiation therapy: ‍noneongoingcompletednot interested, ‍effectiveineffective

Surgery: ‍noneplannedcompleted, ‍effectiveineffective





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neurologic:

- Mental status: ‍alert, oriented to ‍3 spheres, speech ‍intact

- Cranial nerves: ‍all intact

- Strength: ‍intact 5/5 throughout except for ‍4/5 on ‍rightleft ‍, ‍pronator drift

- Sensation: ‍intact throughoutdecreasedabsent to ‍light touch on ‍

- Reflexes: ‍intact 2+ throughout except for ‍1+ on ‍rightleft ‍, ‍plantar downward

- Cerebellar function: ‍intact, ‍normalimpaired finger-nose, ‍normalimpaired rapid alternating movements, ‍normalimpaired heel-shin, Romberg ‍negative, Dix-Hallpike ‍negative

- Gait: ‍steadyunsteady, ‍intactimpaired tandem gait, ‍intactimpaired heel walk and toe walk





ASSESSMENT:

‍Brain Tumor, ‍stable

DDx: primary brain tumor, meningioma, glioma, glioblastoma, astrocytoma, pituitary adenoma, acoustic neuroma, brain metastases, lymphoma, vascular malformations, abscess





PLAN:

Investigations:

- CT scan of the brain

- MRI of the brain

Treatments:

- ‍Antiepileptics

- ‍Analgesics

- ‍Opioids

- ‍Dexamethasone

Further care:

- Referral to neurosurgeon

- Referral to radiation oncologist

- Referral to neurologist

- Referral to physiotherapist

- Referral to occupational therapist

- Referral to social worker

- Follow-up in ‍ ‍weeksmonths

- Return if headache worsens, seizures occur, or if new symptoms develop such as weakness, numbness, or changes in vision or speech