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(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)
A 48-year-old right handed female presented with a 6 month history of progressive decrease of sensation in right upper and lower extremities following a fall after returning from a golf course. She attributed that fall to the loss of sensation, which improved spontaneously over 10 minutes with some residual numbness in the right leg. Her symptoms progressed and she developed difficulty in walking and lifting her right leg. She also complained of neck discomfort and chronic headaches. Neurological examination revealed mild patchy loss of pinprick and light touch sensation in the right upper and lower extremity and trunk with no consistent dermatomal distribution. There was diminished vibration sensation in the right knee. Deep tendon reflex was absent in the right ankle. Plantar reflexes were downgoing. Her gait was stiff with mild circumduction of the right leg. Rest of the motor and cranial nerve examinations were grossly normal.
(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)
A 64 year old male Chinese patient presented with generalized tonic-clonic seizures for a month prior to admission. He had a past history of diabetes, hypertension and previous cerebrovascular accident. Otherwise, he had no other constitutional symptoms such as fever, chills, weight loss etc. Physical examination did not disclose any systemic lymphadenopathy. Subsequent MRI revealed right frontal extra-axial mass with features suggestive of a meningioma which was associated with compression of the anterior portion of the superior sagittal sinus (Fig. 1a). He underwent a craniotomy and tumor excision. During surgery, an avascular right frontal enplaque tumor associated with poor brain-tumor interface was noted. A biopsy of the mass was submitted for frozen section intra-operative consultation during which smears as well as frozen tissue sections were prepared. Following the frozen section result, a subtotal resection was undertaken with residual tumor remaining in the patient.