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COLLEGE OF MEDICINE • UNIVERSITY OF.FLORIDA • GAINESVILLE <br />DEPARTMENT OF SURGERY area code 904. 392-3711 <br />sip 32610 <br />Juae 30, 1975 <br />0 <br />JUL 231975 <br />RE: BALER, Mable <br />27-74-64 <br />Admission: 5-23-75 <br />Discharge: 6-15-75 <br />Hooshang Hooshmand, M. D. <br />2800 South Ocean Drive <br />Suite D <br />Vero Beach, Florida 32960 <br />Dear Dr. Hooshmand: <br />As I am sure you will remember, Ms. Mable Baker was a 59 -year-old white <br />female who has had recent personality change, as well as difficulty <br />with her recent memory. The patient has also bad seizures and visual <br />hallucinations, which have been progressive in the six weeks prior to <br />her admission to the Shands Hospital. She was seen in consultation <br />there by you at Vero Reach, and at that time you performed an angiogram <br />which showed a small left posterior frontal blush. Subsequently, the <br />patient was transferred to the Shands Teaching Hospital for further <br />evaluation and therapy. At the time of admission, the patient's general <br />physical examination was within normal limits. The neurological examination <br />revealed that the patient was awake and alert. The patient was demented,. <br />though, since she was unable to follow commands, or answer questions <br />appropriately. The patient would perseverate as well as confabulate. She <br />did have fluent speech though. We fele that the patient had a receptive <br />dysphasia. Cranial nerves II-XII were intact. There was no papilledema. <br />'The deep tendon reflexes were 2+ and equal and there was no sign of • <br />sensory or motor deficit. We felt that repeat angiography was indicated, <br />and accordingly, a left carotid and vertebral angiogram was performed <br />via a femoral catheter. At that time, we reconfirmed the presence of <br />a left posterior frontal blush with an early filling vein. This was <br />unchanged from your previous arteriogram. Because the angiographic <br />appearance of this lesion was unchanged from your study performed. It <br />was our feeling and Dr. Frank Agee's, Professor of Neuroradiology, that <br />this probably represented a small neoplasm, which as yet was not to the - <br />size to present mass-effect. We also considered the possibility that <br />this was a stroke, though its failure to eimprove angiographically led <br />us from this. • <br />Accordingly, the patient was taken to the Operating Room and under <br />general endotracheal anesthesip. had a left frontotemporal craniotomy. <br />At that time, no neoplasm vas found. Postoperatively, the patient did <br />well, though she developed status seizures, -which were focalized to <br />the right eye and right upper extremity. This responded to intravenous <br />Dilantin. Over the next several days, the patient made a minimal <br />improvement in her receptive speech function and her seizure disorder <br />vas Controlled with Dilantin and Mysoline. <br />Accordingly, we discharged this patient on the 15th of June on Dilantin, <br />200 mg., p.o., b.i.d., and Mysoline, 250 mg., p.o., b.i.d. We plan to <br />have her return to see usin our clinic in six weeks. <br />Thank you very much for the referral of this patient. If you have <br />. further questions in the future, please feel free to contact us. <br />Sincerely yours, <br />George ". Sypert, M. D. <br />Assistant Professor <br />Department of Neurosurgery <br />Dictated by: W. D. Wilson, M. D. <br />emd <br />6-30/7-2-75 <br />.L 172 <br />