Discharge from hospital tentitively scheduled for July 1 2022
There is no reason why the patient could not be discharged today.
The patient no longer needs to wear the collar when sitting and standing. The neck is declared to be basically healed.
There have been no alarming symptoms following the cranioplasty (insertion of the titanium plate) 8 days ago. The risk was that bacteria might be introduced during the surgery (this is a not very rare and very serious complication). The word was observation for one week is needed (I am confident that 1 full week is allowing a massive margin of security and ceased to worry after 4 days).
The patient is weak from being bed ridden and eager to get out of the hospital. Verbal skills have returned to at least far above average. Interpersonal skills are at a level which the author of this blog can't even imagine (low bar). Reasoning fine. Long term memory extraordinary -- to pass time, patient sings the repertoire of Fabrizio d'Andre from memory. Short term memory fine. Patient can walk, walk backwards, walk sideways, and dance better than your author (a very low bar).
The left occular motor nerve remains not normal. It is not possible to exercize a nerve, so the only thing to do is wait and hope for regeneration (this process can last 6 months, it is not clear if progress is slow or zero). The problems are 1) opening the eye -- the Occular motor nerve stimulates the muscles which pull the eye lid up and Patient can open the eye 1 third open and no more. 2) pointing the eye in (to the left - towards the nose). The patient sees double with both eyes open, has strabismus (as squint is wall eyed). 3) focusing close -- the patient has premature presbyopia because the nerve does not send the signal to compress the lens - can't focus closer than about 40 cm (something many healthy adults would envy). The left pupil is dialated.
Here is the referto of the MRI. See the key point is that there is contusion but not detectable ischemia (suspected some small areas of ischemia somewhere). The effects should be temporary. Also Dr Veneziani says the bruised area has no known function -- when it is removed to remove a tumor, there are no known effects. So very good my effort to translate Exam rquested and executed in basal conditions with sequence t1,t2,presente, flair, GRE T2 amd with sequences weighed in diffusion according to axial, sagitale and coronal axes and with an axial sequence aiming in correspondende to the “tratto di rachide” C-4-C6 Extensive craniotomy temporal and fronto- parietal on the left. A collection of extracerebrale fluid collected near the surgical breach of maximum thickness of 18mm. Frontal and temporal bilaterally (walways more evident on the left, there is an extensive area of hyperintensity in the FLAIR and T2 sequences with some characteristics also of a hypointense component i
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