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1. Name- Mohammad Rafique Age- 38/M Mrd no- 1375151 Diagnosis – Non-functional Pituitary Macroadenoma Comorbidities – Obesity

2. c/o difficulty in objects in the lateral aspect in the left eye for 3 months, progressive, now involving the right eye for 1 month. No headache. No diplopia No symptoms related to hormonal excess or deficiency. No trauma/seizures/vomiting

3. O/E :patient conscious, Vitals stable GCS-E4V5M6 -CNS examination Higher mental function normal

4. CRANIAL NERVE EXAMINATION CN 1: B/L sense of smell normal CN2: VA right- 6/9 and left – 6/9 Right – bitemporal hemianopia fundoscopy –mild blurring of disc margins left>right CN 3,4,6 - EOM normal No nystagmus No ptosis Pupils- B/L 3mm equal and reactive with both RAPD.

5. CN 5- intact CN 7 - intact. CN 8 B/L AC>BC webers not lateralised CN 9, 10 Uvula midline Palatal movements normal ,no asymmetry Gag reflex intact

6. CN 11 Shoulder shrugging – Normal on both sides CN 12 No fasciculations of tongue no Tongue deviation

7. MOTOR SYSTEM: Tone Normal in both upper and lower limbs Bulk Normal in both upper and lower limbs

8. Power - right left Upper limb Shoulder- 5/5 5/5 Elbow- 5/5 5/5 Wrist- 5/5 5/5 Lower limb Hip- 5/5 5/5 Knee- 5/5 5/5 Ankle- 5/5 5/5 EHL- 5/5 5/5 Reflexes – Superficial reflexes-present DTR: BJ TJ S KJ AJ Right - 2+ 2+ 2+ 2+ 2+ Left - 2+ 2+ 2+ 2+ 2+ Plantars - both flexors Sensory- intact. Cerebellum- intact. Hormonal workup - normal