Postoperative Lethargy And Left Sided Weakness After Craniotomy

Consult Page

Postop patient with lethargy and left sided weakness, please come assess.

Initial Imaging

None

Walking Thoughts

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  What surgery did the patient have? When did the surgery occur?

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

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  What was the patient’s immediate postoperative exam? Are these symptoms new or expected?

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  What is the patient’s current neurological examination?

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  What is the timing of the patient’s symptoms? Was this a sudden change? What and when was the patient’s last exam?

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  What are the patient’s vitals?

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

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  What imaging does the patient need?

History of Present Illness

A 60 year old female with a history of anxiety, depression, vertigo, and recent cognitive difficulties underwent elective right frontosphenotemporal craniotomy with microsurgical clipping of three aneurysms earlier in the day. The procedure was uncomplicated, and intraoperative cerebral angiography demonstrated complete occlusion of all three aneurysms with no parent vessel stenosis. The patient awoke from anesthesia neurologically intact, and she was transferred to the neurocritical care unit for monitoring and postoperative care. An hour after arriving to the unit, on routine examination by the nurse, she was noted to be lethargic with left upper extremity weakness. The on-call neurosurgery resident was paged urgently.