O.E /61 YEARS/ FEMALE/
HISTORY AND CLINICAL PRESENTATION:
A 61 year old woman who presented on the 27th of April, 2022 for follow up presented with a complaint of scalp swelling. She is a known patient of this facility on management for recurrent scalp masses (giant cell tumour).
NEUROLOGY AND EXAMINATION:
Mass size was about 4 X3 cm located at the parietal region, non tender, firm, non rubbery, non fluctuant, not transillunimating.
INVESTIGATIONS AND TREATMENT:
She had a brain MRI + contrast scan on the 27th of April, 2023 which revealed a soft tissue mass on the parietal region which shows features of bone erosion with mass effect on the brain. Excision biopsy was done on the 8th of May, 2022 which was successful. Post operative conditions were uneventful. About 12 days after the surgery, patient was noticed to have had a generalized tonic seizure of about 2 episodes. 1st spontaneously aborted and the 2nd one was aborted with IV diazepam. The Neurosurgeon was informed and was placed on IV Phenytion, IV furosemide, mannitol and diazepam. Vitals were checked.
On the 20th of May, 2022, she was managed as a case of seizures secondary to raised ICP. GCS examination: E-4, V-2, M-5 ; PERL, R-sided hypotonia
Repeat MRI 1.5T+ contrast was done and revealed para-axial collection. She was reviewed by the oncologist and findings were noted (25/05/2022) radiotherapy was done which failed. She was advised to get Denosumab (Xgvar), do FBC, EUCr, Ca, ALP & LFT. She was placed on Calcium 600mg and Vit D 400IU. She had been on Tabs HCT, Valsartan, Metformin, Atorvastatin, Epilim. Six months after all previous treatment, she presented for follow up in this facility and she reported to have had no seizures during that 6 month period. she was advised by the oncologist to continue the Denosumab therapy for an additional 6 months to make it a year and was to be reviewed a month after.
She presented a month after (15/12/2022) for follow up for recurrent osteoclastoma complicated by focal epilepsy. Complaints was that she has become somnolent and it was attributed to the drug Epilim which she was on. Examinations revealed RUL & LL- 4, LUL& LL- 3, not oriented in time, aphasia improving. Medical plan was to commence Keppra, do EUCr, TFT, Total CK, and consider repeating the imaging investigation. She was also placed on physiotherapy.
A month afterwards, she presented to this facility for follow up (26/1/23), she had been seizure free since last visit but with marked rigidity. TFT & EUCr were all normal. Plan was to do a neuroimaging due to ptosis, somnolence; continue the Keppra, reduce the dose of the Epilim to 500mg nocte, add Elizanidine 2g b.d, continue neurorehabilitation and come for follow up in 2 months time.
Two months afterwards (16/03/2023), she came to this facility for follow up. She had been seizure free since last visit. Complained of somnolence. Plan was to do FBC, tabs bisoprolol 5mg dly, tabs fesolate 400mg b.d x 3/12, see endocrinologist, reduce the dose of the Epilim to 200mg nocte for 2/52, then alternate days for 2/52, continue Keppra and neurorehabilitation. Requested MRI scan revealed no new pathology, Cervical MRI was normal. Dosages of Epilim and Bisoprolol were reduced to 3 times a week and 2.5mg dly respectively. Endocrinologist’s review after some investigations were carried out was acceptable glycaemic control and ?subclinical hypothyroidism. Plan was to be on Galvus met 50mg/1000mg 1 b.d, Bisoprolol 2.5mg dly, Amilodipine 10mg dly, Codoraxc 4mg dly, Co-Dirvan 160/12.5mg dly, ASA 75mg dly, Epilim 500mg 3x in a week, Calcium 600mg every alternate day, Physiotherapy 3x weekly, follow up in 2 weeks time. 2 weeks after, she was presented for follow up and was regular on medications and physiotherapy. Review of systems not contributory.
Kindly revert to us for clarifications where necessary.
Dr. Motajo Modupeoluwa O.
For Team Wellington Clinics Abuja
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