M2 NEUROPATHOLOGY LAB
Match your diagnoses with images 46-50.
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A 7 year old boy was an unrestrained passenger in the front seat when the car in which he was riding was hit by another car on the left side. The air bag deployed, hitting him in the left temple. In the ER, he was unconscious, responding only to painful stimuli by extensor spasms. He had a scalp laceration and fractures of the skull and left jaw. One week after the accident, he was still unconscious. His pupils and eye movements were normal, corneal and gag reflexes were present, and he had no facial weakness. He had weakness, spasticity and brisk tendon reflexes on the right. Both plantar responses were extensor. He lay most of the time with eyes open and had coordinated eye movements following sounds and moving objects. He appeared to sleep at times but could be roused. He died of pneumonia and sepsis 10 days after the accident.
A 4 year old boy had headaches and frequent vomiting in the morning for 2 weeks. Examination by a pediatrician and gastroenterology referral revealed no abnormalities. The symptoms worsened. He became incoordinated and his vision became blurred. Fundoscopic exam revealed papilledema. MRI showed a cystic cerebellar mass. A posterior fossa craniotomy was done and a partly cystic lesion was removed.
A 39-year-old woman with Hodgkin’s disease developed a rapid succession of neurologic deficits. First, there was left facial weakness, followed by ataxia and weakness of the left hand. One month later, a left visual field cut appeared, then left hemiparesis. CSF was normal. MRI showed areas of demyelination without mass effect. Two months later, right hemiparesis and upward gaze paralysis appeared. Gradually she became comatose and died four months after the onset of her illness.
A 14 year old boy had buzzing in the left ear and tingling and pain in the left face for one year. Loss of hearing and vetigo gradually developed. Neurological examination revealed weakness and sensory loss on the left face. MRI revealed a 2.5 cm extra-axial mass in the left cerebellopontine angle, extending into the left auditory meatus. His mother had a spinal cord tumor removed when she was 34 years old. The tumor was removed entirely through a posterior fossa craniotomy.
A 61 year old man had a history of focal seizures involving the left arm for 4 years. Gradually, weakness and spasticity of the left arm and face developed. Imaging studies reveiled an isodense poorly defined, nonenhancing mass in the right posterior frontal area, above the Sylvian fissure. The lesion involved cortex and white matter. Fine calcification was noted on the CT. A biopsy was done.
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