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Volume IV...... No 1II

Volume 4 ....Number 4.... OCTOBER/NOVEMBER 2005 ....VERSION 4.4

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RADIOLOGICAL QUIZ

SHORT CASES

EEG QUIZ

NEUROPATHOLOGY

NEUROANATOMY

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NEUROLOGICAL GATE

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THE MIDLINE

CASES PRESENTED WITH SEIZURES

CASES RESENTED WITH SSPE

CASES PRESENTED WITH CNS LYMPHOMA

CASES PRESENTED WITH CNS GRANULOMA

CASES PRESENTED WITH CNS LIPOMAS

CASES PRESENTED WITH MENINGIOMAS

PARASELLAR / SUPRASELLAR TUMORS

CASES WITH SARCOIDOSIS

CASES WITH CNS SCHISTOSOMIASIS

CASE RECORDS...next cases>> 1,2,3,4,5,6

  1. ENDOLYMPHATIC SAC TUMOR (ELST) CLINICALLY MIMICKING JUGULAR PARAGANGLIOMA. A 68-year-old woman reported an 8-year history of progressive hearing loss of the left ear leading to anacusis.

  2. RATHKE'S CLEFT CYST: A 16 year old female presented with two months of progressively worsening headaches, lethargy and visual disturbances.

  3. ANAPLASTIC EPENDYMOMA: This nine-year-old previously healthy girl presented with nausea, vomiting and hydrocephalus.

  4. DYSEMBRYOPLASTIC NEUROEPITHELIAL TUMOR (DNT): A 31-year-old woman complaining of grand mal seizures since the age of 26 in 1990.

  5. METASTATIC HODGKIN'S DISEASE: A 37 year-old patient who works as a janitor in a fast food restaurant. In May 1998, a year before the present complaint, a chest radiograph showed massive mediastinal lymphadenopathy, which was diagnosed as stage III nodular sclerosing Hodgkin's Disease.

  6.  PIGMENTED CHOROID PLEXUS PAPILLOMA: This nine-year-old previously healthy girl presented with nausea, vomiting and hydrocephalus.

  7.  INTRACRANIAL MESENCHYMAL OSTEOCHONDROMA: A 53-year-old obese man was transferred to the hospital with new onset seizures and a left frontal intracranial tumor diagnosed by a CT scan.

  8.  PINEOCYTOMA WITH NEURONAL DIFFERENTIATION: 11 years old girl presented clinically with impairment of upward conjugate gaze and manifestations of increased intracranial pressure

  9. OPTIC NERVE PILOCYTIC ASTROCYTOMA: An 18-year-old male presented with a large swelling in the right orbit.

  10. TRIGEMINOFACIAL MALIGNANT EPITHELIOID SCHWANNOMA: This 42 year old R handed male presented with an eight week history of progressive left lower motor neuron facial weakness.

  11. ATYPICAL TERATOID/RHABDOID TUMOR OF THE CENTRAL NERVOUS SYSTEM : The patient is a four year old Caucasian girl with a constitutional ring chromosome 22 abnormality.

  12. PILOCYTIC ASTROCYTOMA: This 22 month old white female presented with an 8 month history of posterior neck discomfort manifested by episodic crying, scratching, and pulling her neck posteriorly. Recently the mother reported an onset of "hard coughing."

  13. ACUTE HEMORRHAGIC LEUKOENCEPHALOPATHY: A 32 year old man with symptoms of an upper respiratory infection one week prior presented with mental status changes and a severe occipital headache of two days duration.

  14. HYPOTHALAMIC HAMARTOMA: This 4 year old girl began to develop pubic hair around age 3 and by age 4 had developed breast buds. She was well above the 95th percentile in height and weight. A bone scan showed a bone age of 11 years.

  15. PRIMARY AMEBIC MENINGOENCEPHALITIS: A 19-year-old healthy male fell into stagnant water of the intercostal waterway (salt water of South Florida), following a jet ski accident. He sustained minor superficial injuries but engulfed significant quantities of water and sediment.

  16. PITUITARY ADENOMA: An 82-year-old Caucasian male who developed visual problems in 1989 received a magnetic resonance (MR) scan which revealed a 2 cm pituitary adenoma

  17. CYSTIC GANGLIONEUROCYTOMA: A 12-year-old boy complained of headache of one-month duration and a recent onset of right-sided seizures followed by the loss of consciousness. He had complained of fatigue and attention deficits for about two years.

  18. MICROVASCULITIS ASSOCIATED WITH SYSTEMIC LUPUS ERYTHEMATOSUS: Several weeks after a tooth extraction complicated by a dental abscess that required ampicillin and metronidazole, a 66 year old retired mechanic was admitted to hospital with a one week history of urinary retention, change in personality and headache. Medical history was notable for hypertension, duodenal ulcer, a positive TB skin test and microscopic haematuria.

  19. INTRAVASCULAR MALIGNANT LYMPHOMATOSIS: A 70-year-old female presented with short episodes of aphasia and disorientation resembling complex-focal seizures, with corresponding characteristic EEG features. MRI of the brain was unremarkable.

  20. DESMOPLASTIC INFANTILE GANGLIOGLIOMA: This 6-month-old Caucasian boy presented with a 10-day history of progressive left head tilt, lethargy evolving into obtundation, deteriorating visual and motor skills.

  21. GIANT CHOLESTEROL GRANULOMA OF THE PETROUS PORTION OF THE TEMPORAL BONE: The patient is a 58 year-old man who had a rubella virus infection with acute otitis media as a child and decreased hearing in his right ear since childhood. He presented to the hospital with a two-year history of dizziness and vertigo.

  22. MALIGNANT SOLITARY FIBROUS TUMOR: A 61 year-old female was found in her home moaning and unresponsive. She was taken to hospital where she was uncooperative and too obtunded to provide a history.

  23. LANGERHANS'S CELL HISTIOCYTOSIS: A 29 year-old woman who sustained a minor hit of her head on the closet two months prior.

  24. WEGENER'S GRANULAMATOSIS: This 32-year-old woman underwent mastoid surgery for chronic antibiotic-resistant middle ear "infections" one year prior to the present illness.

  25. PROGRESSIVE SUPRANUCLEAR PALSY: A 70 year-old right-handed, retired obstetrician without significant past medical history presented to a neurologist in 1993 with a four year history of cognitive decline.

  26. CEREBRAL TOXOPLASMOSIS: A 35-year-old male presented after he had experienced two episodes of difficulties in word finding lasting less than 20 minutes each earlier in the day.

  27. HALLERVORDEN-SPATZ DISEASE: The patient was a twenty-four year old female with a long and complicated medical history.

  28. PILOCYTIC ASTROCYTOMA: This 16-year-old young man presented in 1993 with headache, nausea, and vomiting.

  29.  SOLITARY FIBROUS TUMOR OF THE MENINGES: A 41-year-old white female without significant past medical history presented with a six-month history of progressively worsening headache and a more recent onset of progressive visual complaints.

  30. PIGMENTED VILLONODULAR SYNOVITIS: The patient was a 13 year old girl who suffered from back pain and recurrent falls for about one year.

  31. SUBACUTE SCLEROSING PANENCEPHALITIS (SSPE). A 34-year-old right-handed woman was admitted to the hospital because of progressive confusion and visual loss.

  32. GRANULOMATOUS ANGIITIS OF THE CNS. A 43-year-old right-handed paraplegic man was admitted to the hospital because of increasing confusion and aphasia, increasing fatigue, weight loss, and new decubitus ulcers.

  33.  SCHISTOSOMA MANSONI ENCEPHALITIS. A 30-year-old right-handed man was admitted to the hospital because of a generalized tonic–clonic seizure and a left temporal-lobe mass.

  34. NEUROSARCOIDOSIS. A 51-year-old man was admitted to the hospital because of visual "instability" and an intracranial mass.

  35. JUGULAR FORAMEN LIPOMA. A 22-year-old female presented with complaints of slow progressive loss of hearing in the left ear for about 10 years.

  36. PERICALLOSAL LIPOMA. A report of seven cases

  37. FETAL PERICALLOSAL LIPOMA. Case report

  38. SUPERIOR SAGITTAL SINUS THROMBOSIS WITH INFARCTS. A 19-year-old woman presented with a 3-week history of headaches and blurred vision and with new onset of weakness on the right side.

  39. MALIGNANT MIXED GERM CELL TUMOR . A 12-year-old boy presented with an 18-month history of polyuria, nocturia (two to four times a night), and polydipsia.

  40. FACIAL NERVE SCHWANNOMA. A 26-year-old man presented with a 6–8-month history of progressive right-sided facial weakness.

  41. WILSON DISEASE. A 26 years old patient presented clinically with liver cirrhosis, ascites, splenomegaly, and markedly impaired liver function that dated since birth, with recurrent attacks of acute hepatitis, with jaundice and fever.

  42. STURGE- WEBER SYNDROME. A newborn black boy was examined because of bilateral facial port-wine nevi, left-sided glaucoma, and a cloudy cornea.

  43. CHRONIC LIVER DISEASE. Neuroimaging findings in 21 patients

  44. CNS INFECTION IN SYSTEMIC RHEUMATIC DISEASES. Report of three cases

  45. MALIGNANT PINEOBLASTOMA. A 48-year-old woman who was in good health until approximately one week prior to presentation.

  46. CRYPTOCOCCAL MENINGITIS WITH VASCULITIS AND CEREBRAL INFARCT. A 60-year-old male with a history of diabetes mellitus, tobacco use, and hypertension presented with a chief complaint of transient right-handed clumsiness and slurred speech.

  47. RHABDOID MENINGIOMA. Over the past year, this man in late sixties had complained about progressive weakness of concentration and memory disturbances, associated with word finding difficulties.

  48. PILOCYTIC ASTROCYTOMA. A man in his mid-sixties complained about an increasing sense of abdominal "constriction" over a two years period. Eighteen months after the onset of this symptom additional tingling of the legs was perceived.

  49. METASTATIC CARCINOID. A 62 year old man with carcinoid tumor of unknown primary, metastatic to the liver.

  50. DESMOPLASTIC INFANTILE GANGLIOMA. A previously healthy 6-month-old Hispanic female was brought to the emergency department for new onset seizures characterized by six days of intermittent, rhythmic twitching of the left eyelid and arm, drooling, and decreased responsiveness to external stimuli.

  51. MYOPATHY WITH CYTOPLASMIC BODIES AND MULTI-CORES. A 32-year-old woman with anorexia nervosa and depression developed severe weakness, fatigue, and myalgias over several weeks. She had proximal more than distal weakness and dysphagia with nasal regurgitation. She became unable to walk. Sensation and tendon reflexes were unimpaired.

  52. TOXIC POLYNEUROPATHY INDUCED BY HYDROCHLOROQUINE. A 70 year old woman developed, 12 years previously, polyarticular arthritis, butterfly rash, Sicca syndrome and was found to be ANA positive, Coombs positive and ENA positive. Investigations also revealed an IgG lambda paraprotein in serum and urine and 10% of plasma cells in bone marrow biopsy.

  53. TUBERCULOUS RADICULOMYELITIS. A 27-year-old man presented to the clinic because of subacute onset of bilateral lower limb weakness.

  54. SCHISTOSOMA MANSONI MYELOPATHY. A 40-Year-Old Woman with the Rapid Onset of Flaccid Paraplegia

  55. CREUTZFELDT-JAKOB DISEASE: A 68-year-old woman was admitted to the hospital because of rapidly progressive dementia and a gait disorder.

  56. SUBACUTE COMBINED DEGENERATION. A 56 year old man presented with acute onset of paresthesia involving both hands and feet of 15 days duration.

  57. KLUVER-BUCY SYNDROME. We report the clinical characteristics of 6 patients with KBS associated with different etiologies including neurocysticercosis and tuberculous meningitis.

  58. INTERNUCLEAR OPHTHALMOPLEGIA AND TORSIONAL NYSTAGMUS: AN MRI CORRELATE.  A 72-year-old man was admitted with complaints of sudden onset dizziness and vomiting.

  59. CHORDOID MENINGIOMA. In this report, we describe 2 cases of chordoid meningioma, highlighting the clinical, neuroradiological and light microscopic features.

  60. BALÓ’S CONCENTRIC SCLEROSIS. A description of 2 cases with concentric sclerosis.

  61. NEURO-BEHCET. Two cases of neuro-Behçet’s disease mimicking cerebral tumor.

  62. NEOPLASTIC SYRINGOMYELIA. We present 2 cases of spinal hemangioblastoma, one in the conus medullaris and the other in midthoracic region, accompanied by holocord syrinx..

  63. INTRAVENTRICULAR CAVERNOMA. A 22-year-old white woman presented with a 2-month history of ataxia and personality changes, consisting mainly of abulia, headache, and neck pain. Her medical history included significant hypertension and long-standing mental retardation.

  64. PRIMITIVE NEUROECTODERMAL TUMOR (PNET) SHOWING MULTILINEAL DIFFERENTIATION. A boy aged 7 years was investigated for dizziness, diplopia and occasional visual hallucinations over a period of three months.

  65. KEARNS-SAYRE SYNDROME. In this presentation, we have chosen to report on the case of a patient diagnosed as KSS with an associated hypothyroidism, hypoparathyroidism, diabetes mellitus and adrenocortical failure.

  66. MELAS SYNDROME. A 38-year-old right-handed man presented with fever, headache, confusion, partial seizures with secondary generalisation and a right parieto-temporal syndrome.

  67. FUKUYAMA CONGENITAL MUSCULAR DYSTROPHY. Fukuyama congenital muscular dystrophy (FCMD) is the most common congenital muscular dystrophy in Japan and there are isolated reports of non-Japanese patients with FCMD.

  68. KALLMANN SYNDROME. Kallmann syndrome (KS) is a neuronal migration disorder characterised by hypogonadotrophic hypogonadism and anosmia or hyposmia.

  69. SALMONELLA SPINAL OSTEOMYELITIS. A case of vertebral osteomyelitis is presented where initial presumptive diagnosis of tuberculous infection was made on clinico-radiological grounds but eventually turned out to be Salmonella infection upon exploration, biopsy and culture.

  70. BRAIN STEM COMPRESSION SECONDARY TO BASILAR IMPRESSION. A man with 5-6 month history of progressive dysphagia and suboccipital headache.

  71. SPINAL STENOSIS, BASILAR INVAGINATION. 49 yr old female with Down's Syndrome presents with respiratory arrest, and bradycardia.

  72. CEREBRAL EMBOLISM FROM ATRIAL MYXOMA. A 24 year old with sudden hemiplegia.

  73. OCCULT SPINAL DYSRAPHISM. 22 years old female patient presented clinically with cerebellar manifestations, lower cranial nerve dysfunction, bilateral pyramidal manifestation, a cervical subcutaneous lipoma and pes cavus.

  74. STAPHYLOCOCCAL OSTEOMYELITIS WITH EPIDURAL ABSCESS. This 56 year old man had a five year history of Parkinson's disease.

  75.  OSTEOID OSTEOMA OF THE SPINE. A 14 year old male patient repeatedly sought medical advice, complaining of dull aching pain in his left lower back.

  76. GLIOMATOSIS CEREBRI. A 7-year-old girl presented with a 10-day history of progressive headaches, nausea, and vomiting.

  77. SPONTANEOUS INVOLUTION OF PILOCYTIC ASTROCYTOMA IN A PATIENT WITH NEUROFIBROMATOSIS TYPE I. The patient, a 19-year-old man, presented with complaints of "writer's cramp.

  78. ANGIOMYOLIPOMAS IN TUBEROUS SCLEROSIS. A 28-year-old pregnant woman presented with eclampsia. An emergent cesarean section was performed, and recovery was uneventful.

  79. TUBEROUS SCLEROSIS. A term girl had two partial seizures in the 1st day of life.

...next cases>> 1,2,3,4,5,6

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