Mr. Yeoh Ah Peng, 46
sign & symptoms
persistent headache (generalized, common in the morning; not relieved by paracetamol)
vomitting
seizure (on right side, lasted a minute)
risk factors
age (20-60): 46
stress: work as a clerk in priv company
examination
low pulse rate
muscle power in upper and lower right limbs was 3/5 with hypertonia
brisk tendon reflex & upward plantar response
papilloedema in both eyes
investigation
CT scan: wellcircumscribed mass at left cerebral hemisphere with central calcification
MRI: well-defined hypointense lesion in the left cerebral hemisphere with little enhancement of the border zone
dx: Astrocytoma grade II
treatment
increase ICP; worse in the morning d/t recumbency, decrease CSF absorption & rise in PCO2 d/t respiratory depression
irritated grey matter; gliosis & chronic inflammatory changes in surrounding normal brain causing excitotoxicity in adjacent neurons; tumor on left brain hemisphere affect right side of the body
increase ICP, activate mechanoreceptor stimulating chemotactic trigger zone in area postrema
increase ICP, swelling of optic nerves (optic disc)
damaged neural pathways lead to injury to localized brain region
damaged on neural pathways
surgery: removal of tumor
chemotherapy: Temozolomide (TMZ)
radiotherapy
modifying the DNA of tumor cells