# Patient List 2133

13234383

#### Present illness
left drooling and difficult closing left eye for 2 days (since 7/2)

(12) Present Illness
This 55y/o female had the history of
= poliovirus infection with sequelae of left upper limb weakness
= Hypertension
= Arrthymia
= Endometrial precancerous lesion(found in 2016, but loss follow up)
= Mitral valve prolapse
= Insomnia
= Depression disorder
= Syncope
= Headache history before, (but resolved after operation of sinusitis)
= s/p operation for sinusitis
Her baseline ADL was independent. She doesn''t have job now(原先是專櫃銷售員, 因
syncope沒有再工作, 現在比較沒有syncope, 只是常有頭暈, 平常生活自理). She took
many medication for insomnia and depression. She takes Norvasc, Olmectec and
Cardolol without follow-up(別人說這藥好,他就去藥局買來吃, 高血壓沒有再回診)
She had headache history before and the condition got improved after operation for
sinusitis. However, she found more frequent headache in recent 2 weeks but the
pattern was similar as before. She had similar headache again (frontal area,
bilteral, moderate, no scintillation) at 7/1 night. Then she took some insomnia
medication and went to sleep. When she waked up at 7/2 afternoon and she found
left drooling. Difficult swallowing was also mentioned. Then left eye difficult closing
was found at next day. Then she was taken to our ER at 2020/7/3 16:55. At our ER,
Vital sign was TPR: 36.7/90/20, BP: 133/109mmHg.
NE revealed left CN 5(hypoesthesia), 7(left peripheral palsy), 12(tongue deviated
to left) palsy, similar MP. Lab data showed no leukocytosis. Brain CT revealed no
ICH. Whole body CT showed no obvious tumor. Lumbar puncture showed elevated
protein. Under the impression of Multiple cranial nerve syndrome(Left CN5, CN7,
CN12, equivocal CN9, CN10), she was admitted to our ward for futher survey.

#### PE

NE:
no obvious vesicles around ear or face
Consciousness: clear, E4V5M6
Cranial nerve:
no diplopia, EOM no limitation
Left facial hypesthesia(10/7), massenter left weakness
Left peripheral facial palsy, incomplete, corneal reflex(+/-)
symmetric palate movement
dysarthria(Pa較差)
tongue deviation to left, tongue deviation to left weakness
Muscle power:
Upper 5/3(小兒麻痺，跟過去差不多)
Lower 4+/4+
finger-nose-finger: intact

### MRI

Impression :
1. Left VA close to the root exit
zone of the left CN7/ CN8 complex
(source image of MRA IMA: 36),
needing further clinical correlation.
2. No definite apparent tumor or CVA in the posterior fossa.
3. A few nonspecific cerebral WMHs.
4. Left frontal and left maxillary sinusitis.
5. Suggest imaging F/U when clinically indicated.

### Progress

8192 21326904 江雅涵
---
Bokey 100mg/Cap
Famotidine tab
Senokot = senna

8201 06185106 陳林義花
---
Eliquis 5mg/tab = Apixaban
Wecoli 25mg = BETHANECHOL
Famotidine tab
Madopar 250 = levodopa
Syntam granules = Piracetam = Antimyoclonic
Mevalotin 40mg = Pravastatin

8651 09207073 鄭企宏 :+1:
---
Oseni 25/30 = alogliptin為DPP-4，而pioglitazone為TZD
Exforge 5+160mg = Amlodipine (as besylate)/Valsartan
Bokey 100mg/Cap
Soma cap =Carisoprodol）是用於肌肉骨骼疼痛的藥物。
Amaryl M
Imipramine 10mg = TCA inhb, antidepressant
Linicor 20/500mg = lovastatin and nicotinic acid

8661 09393224 李佳蓁
---
Bokey 100mg/Cap
Bisacodyl 栓劑
Famotidine tab
Femara 2.5mg = Letrozole 非類固醇芳香化酶抑制劑(動情素合成抑制劑)
Keppra 錠
Compesolon 錠 Prednisolone
Senokot

8662 21514035 蔡秋梅
---
Actein 600mg 錠 = Acetylcysteine
Famotidine tab
Buscopan 錠劑
Diovan 160mg/tab = VALSARTAN

8692 09881152 洪梅丹
---

Paramol 500mg/ta
Ampicillin cap
lipitor 20mg
Wecoli 25mg = Bethanechol
Concor 5mg
Solaxin 200mg/ta = 肌肉鬆弛劑
Kascoal tab = Simethicone
MgO 250mg
Mopride 5mg = serotonin 5-HT4促進劑
Polupi 50mg/tab = Propylthiouracil
Senokot
GALVUS MET50/850 = vildagliptin 和metformin
Orfarin 3mg 藍 = Warfarin

8702 05114895 盧郁雯 :+1:
---
8751 20693946 林柏宏 :+1:
---
Bokey 100mg/Cap
Crestor 10mg/tab = Rosuvastatin

8762 19930032 陳文鳳
---

8763 17610725 蔡杰男
---
Pioglitazone

9601 01751990 楊能華
---

Hiros = Pseudoephedrine


s/p double lumen placement
she tolerated well without discomfort

clear cons, bil. ptosis, no EOM limitation
Muscle power: upper 5/5 lower 4+/4+

#1. Myasthenia gravis IIb
Mestinon
#2. Thymic hyperplasia
Pre-OP plasmaphersis
Thymectomy