5/8/2012 Case 1

Presented by: Dr. Mark Smethurst - Mount Sinai Medical Center

Clinical History:

The patient is an 82-year-old Chinese woman with a past medical history of hypertension, hyperlipidemia, osteoporosis, aortic regurgitation, meningioma, and blindness of the right eye.  She had also undergone a total hysterectomy at some point in the past, for reasons not stated in her chart.  She was admitted with a diagnosis of right medial sphenoid meningioma, with a very large right occipital, parietal, tentorial and superior cerebellar multicystic component (diagnosed by MRI). She underwent a right occipito-frontal craniotomy for resection of this tumor.  Her post-operative course was complicated by delirium and C. difficile colitis.  She was transferred to rehabilitation six days after surgery.  On admission to rehab, she was alert; but her motor strength and sensation were difficult to assess due to cognitive deficits, with slowed processing and responses.  She inconsistently followed commands, with the aid of her English-speaking daughter at the bedside.  Her right upper extremity strength was 3/5 throughout, with the left upper extremity being 2/5.  Her left lower extremity strength was 0/5.  On the day after admission to the rehab facility she fell from bed, and a subsequent CT showed stable leftward midline shift and stable mass effect on the 4th ventricle. On discharge 11 days later, she required maximal assistance with all ADL's, except that she could spoon feed herself and brush her hair when prompted.