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A 14-year old boy complains of headaches which increase in frequency and severity. The headache is unresponsive to aspirin and acetaminophen. He also complains about double vision. There have been several episodes of vomiting and his gait is unsteady. During the examination, his eyes are open, verbal response is oriented, and he follows orders with appropriate motor response. The patient is unable to stand straight when his eyes are closed. He is also unable to move his heel upward and downward while keeping it on the shin of the other leg. What is the most likely diagnosis?
a. Low-grade astrocytoma.
b. Glioblastoma multiforme.
c. High-grade astrocytoma.
d. Ependymoma.
e. Oligodendroglioma.
I will post all the answers later tonight...................
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AA
pilocytic astrocytoma - cerebellum.
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A. aka Pilocytic astrocytoma
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Good job!
The Answer is A:
The non-responsive headache, double vision, vomiting episodes, and gait disturbance suggest cerebellar dysfunction and brain tumor. The positive Romberg sign (unable to stand straight when his eyes are closed) and heal-to-shin test further indicate cerebellar dysfunction. The location of the lesion strongly suggests the diagnosis of the suspected neoplasm. Cerebellar astrocytoma is the most common, followed by medulloblastoma, ependymoma, and brain stem gliomas. The typical site of childhood astrocytoma is the cerebellum. Medulloblastoma is often located in the vermis of the cerebellum. High-grade astrocytomas are common among adults, while low grade midline astrocytomas are more common among children. Oligodendroglioma and ependymoma have the highest incidence among adults. Glioblastoma multiforme tends to involve the cerebrum. The prognosis is excellent for low-grade cerebellar astrocytomas, but poor for brain stem gliomas and large medulloblastomas. Brain stem gliomas are particularly dangerous because they are not resectable and the location makes even biopsy hazardous.
