Concluded Case

Intrinsic cericomedullary SOL.DD - GLIOMA / LYMPHOMA/ TUMEFACTIVE DEM

New Case 26 yr ,F ,No known comorbidities, presented with subjective non positional vertigo with intermittent vomiting,tinnitus rt side of ear ,occipital intermittent short duration head ache with out any visual symptoms for 4 months and feeling of unstediness, tendency to away to rt side since 1 month. Evaluated by ENT and local hospital ,no relief in symptoms. On exam normal optic fundi. Gaze evoked nystagmus either side ,partial ptosis rt side finger nose incordination rt side with gait ataxia , NORMAL MOTOR PIWER AND DTRS WITH INTACT SENSATIONS. POSSIBLE DIFFERENTIAL DIAGNOSIS.

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Thanks for all answeres. MRI Brain with cervical spine: Well defined, intraaxial,expansile ,dorsally exophytic, diffusion restricting, heterogeneously enhancing SOL involving the Rt lower medulla & upper cervical cord with exophytic component encroaching the floor of 4th ventricle infiltrating in to the adjoining part of rt cerebellar hemisphere, middle cerebellar peduncle. MRS shows elevated choline peak,cr ration > 2.5.No significant perfusion detected. Case was ref to Neurosurgeon and was suggested surgery. Patient has gone for a 2nd opinion. DD : Glioma ( cerico- medulla type), Lymphoma Tumefactive Demyelination
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Thanks for all answeres. MRI Brain with cervical spine: Well defined, intraaxial,expansile ,dorsally exophytic, diffusion restricting, heterogeneously enhancing SOL involving the Rt lower medulla & upper cervical cord with exophytic component encroaching the floor of 4th ventricle infiltrating in to the adjoining part of rt cerebellar hemisphere, middle cerebellar peduncle. MRS shows elevated choline peak,cr ration > 2.5.No significant perfusion detected. Case was ref to Neurosurgeon and was suggested surgery. Patient has gone for a 2nd opinion. DD : Glioma ( cerico- medulla type), Lymphoma Tumefactive Demyelination
Brain stem Glioma involving medulla and extending into upper part of Spinal Chord as MRS shows high Choline ,low NAA and slightly high lipid lactate peaks.
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Brain stem and high cervical cord hyperintensity with cord edema D/d demyelination disease vs mitotic
Demyelinating disease, area postrema syndrome.
Intradural sol with edematous brain
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( RT)CEREBELLAR SYNDROME MS
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