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peds - 3stepstomle
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08-10-2006, 06:45 AM
A 9-year old boy who had been suffering from a gait disturbance for several weeks was found to have a posterior fossa mass on CT scan. Which of the following is the most likely cause for these findings?
1) a berry aneurysm 2) astrocytoma 3) medulloblastoma 4) oligodendroglioma 5) pseudotumor cerebri
08-10-2006, 06:54 AM
even i thought 3 but wen i peaked into my kap notes i realised medullo blasrtoma typically before 7 yrs and 5-10 is typical for astrocytoma
08-10-2006, 07:01 AM
A 9-year-old boy is brought to the emergency department due to an episode of seizures during class. His teacher says that the seizure started suddenly, and he fell to the ground with sustained flexion of the arms and extension of the legs, followed by clonic movements of the whole body. He has also been irritable lately, and his school performance has declined. His parents arrive shortly and say that they recently noticed he was lethargic and frequently complained of headaches, especially in the morning. His medical history is unremarkable. Physical examination reveals decreased muscle strength of the left side of the body, with brisk deep tendon reflexes in the left arm and leg. MRI of the head reveals a space-occupying lesion in the right parietal lobe. What tumor is most likely responsible for this patient's symptoms?
A) Benign astrocytoma B) Medulloblastoma C) Glioblastoma multiforme D) Pinealoma E) Craniopharyngioma
08-10-2006, 07:05 AM
The clinical presentation and MRI findings of this patient are suggestive of a central nervous system (CNS) tumor. In the pediatric population, CNS tumors are the most common solid tumors and the second most common malignancies (after leukemias). Approximately 60% of these tumors are infratentorial, 25% are supratentorial, and 15% arise in the midline. Astrocytomas are the most common histologic type for both supratentorial and infratentorial groups.
(Choice B) Medulloblastoma is the second most common tumor of the posterior fossa in children. Approximately 90% of cases arise from the vermis. (Choice C) Glioblastoma multiforme is a highly malignant astrocytic tumor. It is unlikely in this case because it is usually seen in adults (elderly) patients. (Choice D) Pinealoma develops in the dorsal aspect of the midbrain. Symptoms consist of endocrine syndrome, intracranial hypertension, Parinaud's sign (paralysis of vertical gaze), and Collier's sign (retraction of the eyelid). (Choice E) Craniopharyngiomas arise in the sella turcica, and symptoms usually include visual field defects and an endocrine syndrome. It is characterized by a cystic structure with calcifications. Educational Objective: In the pediatric population, infratentorial tumors are more common than supratentorial tumors, and benign astrocytomas are the most common histologic type in both groups |
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