By Guy M. McKhann Neil D.; Manji Hadi; II
A few 2 hundred brief randomised self-assessment situations combine questions, illustrations and certain explanatory solutions, protecting all features of neurological illnesses and disorders.
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Additional resources for Self-assessment colour review of clinical neurology and neurosurgery
53 i. The MRI shows a lesion in the right frontal white matter that extends to the cortex anteriorly and the genu of the corpus callosum posteriorly. The cortical sulci are expanded and effaced. The right lateral ventricle is compressed. The signal intensity is the same as, or slightly lower than that of gray matter, and the lesion does not enhance with gadolinium. ii. These findings, along with the clinical presentation of a first seizure at age 38 years, suggest a low grade primary glial neoplasm such as astrocytoma, oligodendroglioma, or mixed tumor.
T1 sequences demonstrate anatomy well and serve as background when MRI contrast agents are used. T2 sequences show many focal pathologic lesions as areas of high signal, including primary and metastatic tumors, infarcts, demyelination, cerebritis, and abscesses. ii. This lesion involves the left suprasellar, crural, ambient, and quadrigeminal plate cisterns. It is definitely extra-axial (outside the brain parenchyma), and displaces the midbrain to the right. The patient’s symptoms are due to compression of the second and third divisions of the trigeminal nerve, which is surrounded by this lesion.
Iv. Is DNA testing available for the differential diagnosis? 26a 26b 35 25, 26: Answers 25 i. The essential investigations after a FBC, ESR, B12 and folate, autoimmune profile, ACE, and CXR would be MRI brain and cord, VER (searching for the previous lesion), and CSF examination (95% of those with multiple sclerosis will have a pattern of oligoclonal bands that is different and greater than the serum). Her cranial MRI shows characteristic inflammatory demyelinating lesions which are both peri-ventricular and involve the corpus callosum.