Case Scenario

• James Randall, a 54 year-old male, right-handed, is 48 hours s/p surgical excision of a benign brainstem/cerebellar tumor.  He initially presented with vertigo, nystagmus and vomiting, double vision and dysphagia at emergency care.

• Past Medical History (PMH): Right partial thyroidectomy, insomnia, chronic bronchitis; difficulty with gait, urinary incontinence.

• Social History: Married; one child (21years old); He is a professor at a local university.

• Surgical History: status post (s/p) Thyroidectomy for a benign neoplasm, TURP

• Post-op day 1, pt presented with difficulty verbalizing and increased frustration. Neurosurgeon ordered a STAT Brain and cervical spinal CT without contrast with unremarkable results. Subsequent MRIs were ordered and remarkable for attenuation of the L-MCA distribution representing an acute infarct. 

Review of Systems

General- S/P surgical excision of benign brainstem/cerebellar tumor

HEENT- Negative headaches, blurred vision, eye pain, ear pain, ear discharge.  Negative congestion, or runny nose. Negative sore throat, but  changes in voice are noted.  

Pulmonary-  Negative cough, shortness of breath, wheezing, 

Cardiovascular-  Negative skipped beats, chest pain, negative easy bruising. 

Gastrointestinal-  Negative abdominal pain, changes in appetite, vomiting, constipation, diarrhea, blood in stool

Musculoskeletal-  Negative pain, swelling, or other injury

Skin- Negative Rashes,  Itching

Neurologic- Positive weakness

Genitourinary- Negative pain with urination or increased frequency. Negative blood in the urine.

Psychiatric-  Negative depression, anxiety or suicidal ideation.