Tumor Haze Caused a Missed Shave: Facial Shaving Hemineglect

Abstract

A 68-year-old male pulled his truck over on the side of the road when he began having difficulty in driving. Sometime later, a policeman pulled over and was concerned about the patient’s altered mental status and had emergency medical service bring him to Mayo Clinic in Jacksonville, Florida. The patient lives alone at home and reported he had left-sided weakness for 2 weeks. He was noted to have shaved only the right side of his face from the midline, whereas the left side was unshaven, appearing to have several days of growth (Figure 1A). He neglected verbal, mechanical, and noxious stimuli coming from his left side. Other neurological findings included left lower facial droop, pronator drift, lower extremity weakness, and bilateral Babinski sign. The magnetic resonance imaging with contrast revealed a large lobulated enhancing mass in right frontal lobe with vasogenic edema extending into the parietal lobe causing midline shift (Figure 1B). The patient underwent resection of the mass. The pathology demonstrated metastatic squamous cell carcinoma. His left hemineglect and hemiparesis resolved by postoperative day 6, and he was discharged home. Figure 1. A, Anterior view of the patient’s face. B, T1-weighted magnetic resonance image (MRI) with gadolinium revealed a large lobulated enhancing mass in right frontal lobe with vasogenic edema extending into the parietal lobe causing midline shift.