40 Year Old Lady with History of Past Head Injury Presenting With Recent Voice Change

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This is a HIPAA de-identified open-online-patient-record with initial information in patient's voice, posted here August 2017 after collecting informed patient consent (form downloadable Click Here).

A 40-year-old lady presented with the history of significant head injury 5 years back where she was comatose for 12 days and regained consciousness with left sided weakness from which she recovered and started doing normal household work. From last 2 months attendants started noticing that her voice was changing, slurring gradualy and they also told that she was coughing each time she tried to drink water or milk. She was feeling a sense of imbalance.

On examination, respiratory rate was 27 per minute, regular, no pallor, cyanosis, clubbing. Her higher mental function was normal . She has had dysarthria? scanning speech, and swaying to right side, however it is not clear if it was due to her weakness. All cranial nerves normal except 10 and 11 (palatal palsy) with absent Gag reflex and Uvula was central in position.

Her muscle tone is normal with no atrophy, power grade 4 in all muscle groups in right upper limb and lower limb (?residual). Sensory system is normal. Coordination ?? impaired on right side (cannot be commented due to weakness). All superficial reflexes intact but all deep reflexes are exaggerated bilaterally. On respiratory examination, she has right sided chest crackles. Her CVS examination is apparently normal.

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