ICU CASE

BRAIN MASS, LEFT FRONTO-TEMPORO-PARIETAL MASS, WITH MASS

EFFECT, TO CONSIDER CNS LYMPHOMA VS. GLIOMA
PROFILE
Name: SVB
Aug 11, 1968
Female
Filipino
Roman catholic
Occupation – N/A
Married
Admission date and time: February 17, 2019 at 2:24PM

OBESE – 70kg, 160cm

No known allergies

ASSESSMENT
With pressure ulcer – sacral stage 1
2x3 reddish
2.2 cm scratch

Feb 18 Input 2640

Output 1950
Fluid balance +700

Clear breath sounds

Abdomen nontender
No edema

Feb 19 GCS – 12 to 13
Follows command
With right and left disorientation
Aphasic
Pupils 3mm EBTRL
Isoconic full EDMS
+ ptosis, left
Right central facial palsy
No bleeding episodes
No Babinski
No Hoffman
Sinus rhythm
Motor:
LUE 2/5
LLE 1/5
Soft nontender abdomen
Normoactive bowel sounds

Tube feeding 50cc/hr

PNSS 1L x 80cc/hr

FOR BIOPSY OF BRAIN LESION

HISTORY

Patient is a 50/F known CNS lymphoma (2018) came due to decreased in sensorium. Baseline
with weakness on the right side and feeds per orem solid food and spends most of the day
bedbound. At around 5PM, patient was noted to have decrease in sensorium with inability to
open eyes and was noted to gesture and hold her head (headache) No interventions done. Due
to persistence, went to a nearby hospital in Malolos at 9AM however was advised to be sent
here instead. No diagnostics done.

PMH CNS lymphoma (Oct 2018) presented as headache. Previously on dexamethasone 4mg
BID, diagnosed via MRI. No biopsy or interventions done.

September 2018, headache partially relieved by pain meds. October 2018, MRI done noted
primary impression of lymphoma – herbal intake instead of medical intervention.

January 2019, wheelchair borne – current baseline: bedbound, feeds per orem with weakness
right side

FH HTN, DM
PSHx U/R

CHIEF COMPLAINT: Decrease in sensorium

LABS
2D ECHO
- Normal left ventricular diameter, left ventricular mass index and relative wall thickness
- Adequate wall motion and contractility
- Normal diastolic function
- Normal right ventricular size
- Normal left atrial diameter and left atrial volume index

CHEST XRAY
- No infiltrates seen
- Minimal pleural effusion, left sided
- Cardiomegaly

ECG
- Sinus rhythm 64bpm

ABG
7.457
36.3
111.1
25.7
98.6% at 28% FiO2 dFiO2 21%

CBC
Feb 18
Hgb – 16.5
Hct – 5.43
WBC – 16 340
Neutrophils – 84
Lymphocytes – 11
Monocytes – 5
PC – 333 000
PT control – 12.3
Test – 11.2
INR – 0.93

Na – 140
K – 4.3
Mg – 2.9

BUN – 11
Crea – 0.80

Feb 19
Na – 144
K – 3.4

UTZ
Ovoid structure in the left suprascapular region, primary consideration is lipoma

NECK CT SCAN
Left frontal and ethmoid aircells – trace mucosal thickening
Left temporal and basal ganglia – brain parenchyma shows ill-defined area of hypodensity with
effaced sulci

There is a right ward midline shift and compressed left lateral ventricle

MRI
Brain – lesions in the left vertebral hemisphere with interval progression in number, size and
perilesional edema

TSH
0.4 (NV: 0.55 – 4.78)

Glycohemoglobin
5.8 - prediabetes