CSD 482: N EUROSCIENCE FOR C OMMUNICATION D ISORDERS Case 2 Chief Complaint A 13
ID: 3516254 • Letter: C
Question
CSD 482: NEUROSCIENCE FOR COMMUNICATION DISORDERS Case 2
Chief Complaint
A 13-year-old boy was brought to the pediatrician’s office because of 2 months of progressive left occipital headaches, nausea, slurred speech, and unsteadiness.
History
The patient was well until 2 months previously, when he began having headaches, which were initially attributed to a sinus infection. The headaches gradually worsened, with headache mainly in the left occipital area, and sometimes accompanied by nausea and vomiting, but no visual changes. The headaches were worse at night and in the early morning hours. His teachers noticed that over the past few months he had had some difficulty concentrating and learning new material at school. During the week prior to presentation his mother noted increasing gait instability and mildly slurred speech and decided to bring him to the pediatrician.
Neurological Exam
Mental Status: Alert and Oriented. Speech fluent, with normal repetition and comprehension.
Cranial Nerves: Pupils equal round and reactive to light. Visual fields full. Extraocular movements were full, but there was horizontal nystagmus on lateral gaze bilaterally, and vertical nystagmus on upgaze worse than downgaze. In addition, the vestibulo- ocular reflex was not fully suppressed by visual fixation. Facial sensation and corneal reflexes intact. Face symmetrical. Hearing intact to whisper bilaterally. Speech slightly slurred and with an irregular rate. Normal palate movements and gag reflex. Normal sternomastoid and trapezius strength. Tongue midline.
Motor: No drift. Normal tone and muscle strength.
Coordination: Marked dysmetria on finger-to-nose testing, worse on the left, with approximately 2 inches of error. There was also dysdiadochokinesia, with inaccurate rapid alternating movements, worse on the left side.
Gait: Wide-based, with feet approximately 2 feet apart, and unsteady, staggering to the left. Unable to perform tandem gait. On the Romberg test with feet 4 inches apart there was no worsening of unsteadiness (unable to stand with feet together even with eyes open).
Sensory: Intact light touch, pinprick, vibration, and joint position sense. Intact graphesthesia and stereognosis.
Localization and Differential Diagnosis
1) Where is the lesion? What are the main symptoms or signs that lead you to this lesion location?
2) What is the most likely diagnosis? What are some other possible diagnoses?
Explanation / Answer
1. Cerebellum.( its cerebellar lesion).
Main signs and Symptoms suggestive of this includes
2.
Patient need to asked for these information for some more history to be suggestive of other possible diagnoses.