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PostPosted: 11 Feb 2018 13:47 
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Hi Badri
I am really on cloud nine when I read your message for two reasons. The first is that I am happy that the valued opinion given by our friend and class mate Dr Murali on this case really vindicates my stand on this case. Given the history and the present state of the patient his advice to follow the old dictum 'discretion is the better part of valour' is timely. I am not the one usually inclined to follow the protocols when faced with medical situations. Another reason for my happiness is that Dr Murali is able to recall even the ward where I was admitted for headache and hemianopia under Dr BRM. I am really delighted to know that he has me in the remotest corner of his hard disc. That is really a great of him. Badri, you must be remembering the story which Dr Murali is talking about and which I had written in this forum under 'personal story' under the caption ' ALL IS WELL THAT ENDS WELL'. If you can please forward this story also to him along with my regards and best wishes.

UA Mohammed


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PostPosted: 11 Feb 2018 14:09 
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Hi Badri
I am on cloud nine when I read the message you posted for two reasons. The first is the valued opinion given by our class mate and neurosurgeon Dr Murali vindicates my stand on this case. Given the history and the present state of the patient in an almost normal condition and without any discernible signs and symptoms pertaining to this large lesion, his advice to follow the old dictum ' discretion is the better part of the valour' is really superb and unlike the opinions of others we got from here.

The second reason for my happiness is that a small man, me, has a place in the remotest corner of his hard disc and that he could recall even the ward where I was admitted for my headache under Dr BRM. That is really very great of him. My salute to him.
Badri, you must be remembering the story which Dr Murali is referring to and which I had written in this forum under 'Personal story' under the caption ' ALL IS WELL THAT ENDS WELL'. If possible please forward this story to Dr Muali along with my regards and best wishes to him and his family. If you let me know his mail address, it would be better.

UA Mohammed


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PostPosted: 19 Mar 2020 17:24 
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Dear friends
A good number of members of this forum are aware of my patient with a large intracranial tumour known since 2015. As was noted earlier though he had this big tumour he did not have any signs or symptoms related to this lesion, like headache or vomiting. No seizure either. No long tract involvement. Both fundi were normal. He used walk and climb stairs without any difficulty. Incidentally his office was upstairs. As stated in my earlier postings all the neurosurgeons he consulted advised him immediate surgery. From the beginning I was of the opinion that if such a large tumour was removed from one side of the cranium, the vacuum created may cause pull of the other side and cause devastating and unpredictable effect on him. When he was completely normal in every other respect, should we risk a great surgery? Still I left the choice to the patient and his family. The patient was not at all willing for surgery. He was a diabetic and hypertensive with a recurrent filarial cellulitis left leg. He was carrying on his normal activity until about six month ago when he started having very minimal paresis left leg. Still he used to come to my clinic without support. But the weakness slowly progressed and a little later extended to the left upper limb also during the last few weeks and he had become almost wheelchair bound. Still surprisingly he was fully conscious and used to talk coherently and did not have any intracranial features at all. A few weeks ago when he developed retention urine and had urinary tract infection. I admitted him for the first time for treating his urinary tract infection and managing his worsening diabetic state. During the hospital stay he started having recurrent spontaneous and paroxysmal loss of consciousness lasting for a few minutes without any preceding involuntary movements. Between the episodes he did not have any conscious disturbance and his voice became slightly feeble but still coherent. A CT scan brain was done. It showed only slight increase in the size of tumour. It was 5.8 x 5.5 cm in the month of May, 2019 and the present one is 5.47 x 7.41 cm. A notable new finding in the new one is hypodensity is noted in the right temporal region that may explain the present left sided hemiplegia. With same neurological findings when he became slightly stable I discharged him with advice to continue supportive treatment. After reaching home also there was no new development for two days and on the third day morning, he developed sudden cardiac arrest and expired.
From any angle this case has been an unusual one. With such a big mass in the brain with least clinical manifestation he had normal life for nearly four and a half years since detection the lesion. He did not have much suffering even during his last days. What would have been his suffering had he undergone a surgical treatment is any body’s guess.

UA Mohammed


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PostPosted: 03 May 2020 20:21 
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Hi Mohammed,

An interesting case and followed up very well by you to the end. The end result was expected years ago and as you mention he had a reasonably uneventful 4 years. Immediate surgery, if it had been successful would still have left him with God knows what residual problems. He may have had a miserable life if surgery did not result in immediate death. Decisions are difficult and the best person to decide should be the patient himself. Doctors must never force a patient to undergo surgery in circumstances like this.


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PostPosted: 05 May 2020 15:54 
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Hi Badri
Though he had a massive space occupying lesion in the cranium, he had very little symptoms or signs. I was disinclined towards a surgery which might result in an unpredictable catastrophe in an otherwise normally active man. Thankfully this patient and his family are also in agreement with my view. Having seen him in close quarters for so many years, i have no guilty feeling at all because of the deferment of the surgery.
Also to be noted that though posted some years ago still this article is continuously read by visitors in this forum. This year march 30 the number visitors was 7356 and on 10th April it was 7425 and today it is 7722. I am thankful for all those who visited this page.

UA Mohammed


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PostPosted: 08 May 2020 09:20 
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Hi Mohammed,

Interesting a lot of people are reading this topic. Pity they don't make any comments. It would be good to hear their comments.


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