Saturday, February 18, 2017

A Neurology Case Discussion


Hey guys, let's ponder upon the following case.
Before reading this case, just know that this is a case of cerebellar tumor. Now try to localize the tumor in the cerebellum by taking help of the symptoms of this kid. This will help you in the differential diagnosis given later.

A 4 year old complains of headache, drowsiness and occasional diplopia; he is unsteady on his feet with frequent falls. Examination demonstrates truncal ataxia, sometimes accompanied by incoordination of the limbs; variable ophthalmoparesis and papilledema on fundoscopic examination.

Any guesses on what this could be?

Ok so here goes the case discussion:

Medulloblastoma typically presents with a midline cerebellar syndrome, with hydrocephalus and resultant increased intracranial pressure.
Clinically, it can be distinguished from ependymoma involving the fourth ventricle by the early appearance of nausea and vomiting in the latter, due to involvement of area postrema. Cranial nerve palsies may appear with either tumor, and increasing intracranial pressure is typical of both.
The predominance of signs suggesting primary involvement of vermis distinguishes medulloblastoma from cystic or solid astrocytoma of the cerebellum which typically involves a cerebellar hemisphere rather than the vermis. Although rarely there are midline midline astrocytomas.

You are awesome if you were able to get this one right. :)

-VM

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