M2 NEUROPATHOLOGY LAB
Match the case histories with images 41-45.
41 42 43 44 45
A 70-year-old man had a sudden onset of slurring of speech and right arm weakness which resolved in 30 minutes. However, right hemiparesis, facial paralysis, and slurred speech reappeared insidiously within a few days and progressed. MRI revealed an enhancing mass involving the left frontal lobe, basal ganglia, and internal capsule. The patient had AIDS which he had presumably acquired from a blood transfusion several years earlier, in the course of partial gastrectomy for peptic ulcer.
A 50-year-old man had seizures in the left hand for several years. Then weakness of the hand and arm developed, followed by a drop of the left side of the mouth. Seizures became more frequent and headaches appeared. Brain MRI revealed a right parasagittal extra-axial mass which was totally resected, leading to complete recovery.
A 74-year-old woman who had a right parietal headache for one month developed weakness and numbness of the left hand and began to drop things. The whole left arm then became weak, and drooping of the left side of the mouth developed, along with a sensation of thick tongue. Weakness progressed to involve her left leg, and a defect in the left visual field appeared. MRI revealed an enhancing right parietal mass. A craniotomy was done, and a necrotic tumor was partially resected.
A 3 year-old girl had a cerebellar tumor which was partially resected. She received intrathecal chemotherapy and craniospinal irradiation and was stable for ten months. Then, she developed tingling of the toes, back pain, and weakness in the legs. A lumbar puncture revealed tumor cells in the CSF. Symptoms progressed, and within three months she lost sensation below the chest, and became paraplegic and incontinent. Additional chemotherapy and irradiation was given, but she died four months later.
A 62-year-old woman who had had mastectomy for breast cancer two years earlier gradually became confused, ataxic, weak, and dysarthric. Head CT was normal. CSF was clear with protein 136 mg/dl, glucose 14 mg/dl, and 30 lymphocytes. Her condition worsened, and a succession of cranial nerve deficits appeared. She deteriorated further, became comatose, and died 2 ½ months after the onset of the neurological symptoms.
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