Left sided numbness

Chief Complaint A 69 y-o-f came with the complaint left sided numbness over the face and arm. She is not able to chew food properly on left side or use her left arm to perform routine activities. History History positive for breast cancer and underwent surgery and chemotherapy. Vitals BP-125/80 mmhg, HR-74 bpm, Breathing-17 breaths/min, Temp-98.1 degree F Physical examination Examination shows paresis in left hand. Lab reports wnl. CT & MRI Brain was done which show multiple 1 cm - 1.5 cm nodular lesions in the brain, CT chest shows a 2cm × 2.5cm × 3cm mass in the left lung. Biopsy of the lung mass shows central nervous system metastasis. Treatment How the case should be managed.

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Biopsy of lung lesion shows CNS metastasis.??. Is it a primary in the lung or metastasis in the lung.Hiw ever this is a case of disseminated malignancy. Primary site ?? Lung / secondary in the lung and brain. Ref the case to Oncologist for further management.

Brain lesions -metastasis only.lung lesion primary/ metastasis.

What were the hormone and HER 2 status of the breast primary? Is the chest mass a breast or a second primary? What do you mean by " biopsy of the lung mass shows CNS metastasis", this statement makes no sense. How many CNS lesions are there and where are they present? In addition for treatment, we need to know what the primary is (breast?, lung?, anything else), and if this is breast then what is the hormone and HER2 status of the tumor. Based on the extensive CNS metastasis I think this patient probably has HER2+ breast cancer or SCLC of the lung, but you need to give more information about the pathology. Since the patient has paresis, I would consider starting the patient on dexamethasone 4 mg BID which shows decrease vasogenic edema and help with the paresis. Then there is the question of starting prophylaxis for seizures as this patient has multiple CNS lesions. (which depends on the location of the lesions) You should refer this patient ASAP to a medical oncologist for a workup and management

Metastasis with complications. Chemoradiotherapy or palliative therapy and after proper evaluation and assessment by oncologist .

Thanks Dr Pushkar Bhomia

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Chemotherapy + Radiotherapy Physiotherapy Symptomatic treatment Ref to Oncologist

Possibilities of secondary metastasis of ca breast . Needs oncchologist opinion and urgen treatment as may start convulsions

Numbness can occur along a single nerve on one side of the body, or it may occur symmetrically, on both sides of the body. Numbness is often caused by damage, irritation or compression of nerves. Treatments Here are a few tips for dealing with numb arms: If you tend to have numb arms in the morning, try adjusting your sleeping position. A wedge pillow can keep you from sleeping on your arms. When your arm becomes numb during the day, try performing some simple movements to improve circulation. Avoid repetitive shoulder, arm, wrist, and finger movements. Try to disrupt the pattern by taking frequent breaks from these movements. If arm numbness is interfering with your work or other daily activities, it’s a good idea to let you check it out. Specific treatments depend on the cause. Treating the underlying condition may ease your symptoms. Treatment for numbness and tingling depends on its cause. Numbness related to MS is usually relatively harmless and painless. Niacin, a B complex vitamin, may help reduce inflammation and related numbness. In cases of severe or painful numbness, treatment may involve a short round of corticosteroids, which also quickens recovery by reducing inflammation. Several medications designed to treat different conditions may also help reduce numbness and tingling associated with MS, such as: gabapentin pregabalin carbamazepine phenytoin amitriptyline, imipramine, and nortriptyline Other conditions Several different treatment plans may help reduce or manage numbness and tingling not related to MS, such as: Stroke. Medications to treat clots for ischemic stroke (if within 3 hours of first symptoms), and surgery or endovascular procedures for hemorrhagic stroke. Transverse myelitis. Pain medications, antivirals, intravenous immunoglobulin, or plasma exchange therapy. Meningitis. Antibiotics, anticonvulsants, and corticosteroids. Tumors. Surgery, radiation therapy, chemotherapy, and other drug therapies. Diabetic neuropathy. Physical activity, healthful diet, following diabetes treatment plans, checking feet daily for changes, and getting regular foot exams. Carpal tunnel. Wrist braces, over-the-counter pain medications, nerve gliding exercises, or surgery. Avoiding trigger activities. Pernicious anemia. Vitamin B12 injections, pills, or nose gels or sprays. Hypocalcemia and hypomagnesemia. Infusions or supplements, dietary changes, staying away from triggers, treating underlying causes.

Looks metastasis Advance case of malignancy Req chemo and radiotherapy Oncologist opinion Physiotherapy too

Early medical management is advisable. Adv MRI brain and PET scan.

CP angle facial nerve involvement by metastasis to be thought

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