Neoplastic Disease

Abstract

A 57-year-old man with lung cancer for 12 months developed a nonspecific holocranial headache about 3 weeks ago. Over the past 5 days, he complained of double vision, as well as difficulty chewing and swallowing. He had also noticed pain radiating down his left leg to his foot and weakness on that side while walking. Neurological examination revealed an MMSE of 23/30 with deficits in attention/orientation, calculation and multi-stage commands. There was also evidence of bilateral eye abduction paresis, facial diplegia, and tongue weakness. Motor examination revealed weakness in left foot intrinsics, ankle dorsi- and plantarflexion, as well as hip abduction. Sensory examination was significant for reduced pinprick on the left lateral leg, dorsum, and plantar surface of the foot. Left ankle reflex examination was diminished.