Change In Exam After Brain Tumor Biopsy

Consult Page

Hi there, for room 21, patient seems sleepier, please come evaluate him.

Initial Imaging

None

Walking Thoughts

• π

  Why is the patient admitted? Did the patient have surgery and if so, what type of surgery and when did it occur?

• π

  Where is the patient currently located (e.g. floor vs. neurocritical care unit)?

• π

  If applicable, what was the patient’s immediate postoperative exam? Are these symptoms new or expected?

• π

  What is the patient’s current neurological exam? What and when was the patient’s last exam?

• π

  How sleepy is he? What is the timing of the patient’s symptoms? Was this a sudden change or progressive?

• π

  What are his ABCs? Is he protecting his airway?

• π

  What are his vital signs?

• π

  What imaging does the patient need?

• π

  Has the patient received any recent medications that could confound the examination (e.g. pain medication)?

• π

  If applicable, is the patient at risk for any postsurgical complications (e.g. seizures or hemorrhage)?

• π

  Does he need to be transferred to a monitored bed?

• π

  Is he on any anticoagulant or antiplatelet medication?

History of Present Illness

A healthy 63 year old male is currently admitted to the neurosurgical floor after recently undergoing a right stereotactic biopsy of a brain lesion. He initially presented as a transfer from an outside hospital with several months of progressive left-sided weakness. About 5 months ago, he woke up with left arm numbness and tingling. Since then, he developed worsening left arm and leg weakness. In the week prior to presentation, he could no longer move his left arm and leg and presented to an outside hospital. MRI there demonstrated a 4 cm mass of the right thalamus, basal ganglia, centrum semiovale, and midbrain with mild hydrocephalus. He was started on dexamethasone and levetiracetam and transferred to our institution.

Two days prior, he underwent a right stereotactic biopsy of the lesion with preliminary pathology consistent with a high grade glioma. The procedure was uncomplicated, and the patient awoke from anesthesia at his neurological baseline with stable hemiplegia. An immediate postoperative head CT showed postsurgical changes without new hemorrhage or abnormality. He recovered well in the neurocritical care unit for one day and was then transferred to the floor. On postoperative day 2, the nurse noted that he was sleepier on routine examination and urgently paged the on-call neurosurgery pager.