Brain Lesions Flashcards
What visual problem is associated with a pituitary tumor compressing the optic chiasm?
Bitemporal hemianopsia
A 66yo pt w/ frequent falls, several-month hx of anxiety and unwillingness to leave home.
On exam, mild impairment of vertical gaze on smooth pursuit/saccades, mild axial rigidity and minimal rigidity of UEs, mild slowness of movement on finger tapping, hand opening, and wrist opposition. Posture wnl. Gait is tentative/awkward but w/o shuffling, ataxia, or tremor. Pt is slow in arising from a chair.
What is the most likely diagnosis?
Progressive supranuclear palsy
Pt w/ severe occipital headache, b/l papilledema, and no other abnormalities. Pt has chronic acne treated w/ isotretinoin.
LP w/ elevated opening pressure w/ no cells. 62mg/dl glucose and 22mg/dl protein. CT is normal.
What is the most likely diagnosis?
Pseudotumor cerebri
A 79yo pt w/ deteriorating mental state over the past 3 weeks has exaggerated startle response w/ violent myoclonus that is elicited by turning on the room lights, speaking loudly, or touching the patient. Myoclonic jerks are also seen.
What is the most likely diagnosis?
Spongiform encephalopathy
A pt presents w/ slowly progressive gait disorder, followed by impairment of mental function, and sphincteric incontinence. No papilledema or HA are reported.
What is the most likely diagnosis?
Normal pressure hydrocephalus
A 6yo pt fell several times over the past 6 months. MSE wnl. Smooth pursuit, saccadic movements impaired. Worse w/ vertical gaze. Full ROM w/ doll head maneuver. Mild symmetric rigidity/bradykinesia, no tremor. MRI/CSF/labs unremarkable.
What is the most likely diagnosis?
Progressive supranuclear palsy
Pt w/ acute onset of pain and decreased vision in the R eye. Colors look faded when viewed through the R eye. On exam, patient has a R afferent pupillary defect and a swollen R optic disc. Pt spontaneously recovers over the next 6 weeks.
What is likely to develop later?
Multiple sclerosis
A 28yo w/ emotional lability and impulsivity. LFTs elevated. Close relative had similar sx and died at 30yo from hepatic failure. Which blood level would be diagnostic?
Ceruloplasmin
A pt w/ several days of fever and severe HA presents to the ED c/o generalized seizure. Pt is confused and somnolent. Also reports to have been irritable and has c/o foul smells. T2 MRI displayed (hypersensitivity of L temporal).
What is the most likely diagnosis?
Herpes encephalitis
9yo F w/ 3 mo h/o seemingly unprovoked bouts of laughter. Worse when not sleeping well. Pt does not feel happy during these episodes. Started menstruating 6mos ago, currently at Tanner stage 4.
What is the most likely diagnosis?
Hypothalamic hamartoma
A 5yo w/ 4 mo h/o morning headache, vomiting, and recent problems w/ gait, falls, and diplopia.
What is the most likely diagnosis?
Medulloblastoma
A 70yo develops flaccid paralysis following severe water intoxication. He develops dysphagia and dysarthria w/o other cranial nerve involvement. Sensory exam is limited but grossly normal, DTRs are symmetric, and cognition is intact.
What is the most likely diagnosis?
Central pontine myelinolysis
A young adult gained 70lbs in the last year and is c/o daily severe HA sometimes associated w/ graying out of vision. Papilledema present. CT and MRI brain w/o abnormalities, but ventricles are smaller than usual.
What is the goal of treatment in this case?
Prevent blindness
Superior homonymous quadrantic defects in the visual fields result from lesions to which of the following structures?
Temporal optic radiations
Tremor w/ a frequency of ~3Hz, irregular amplitude, most evident towards the end of reaching movements.
What is the most likely diagnosis?
Cerebellar tumor
