USMLE Forum Archives - USMLE Step 1 - Pathology 21
Pathology 21
mosaabma - 10-24-06 15:23
A 50-year-old woman who works as a paralegal in a law firm comes to her local doctor because of
problems with sleep. The patient says that over the past several weeks, she hasn't slept well, feels
tired, and has had headaches. She does not smoke or drink alcohol, except on special occasions,
and does not take any medications. The patient's pupils are 5 mm in size, equal and reactive,
with both the direct and consensual light reflexes intact. Accommodation is unimpaired.
Examination of the visual fields and funduscopy are unremarkable. Extraocular movements reveal
normal conjugate, oblique, and downward movement, but she is unable to look upwards. No other
abnormalities are found on the neurological examination. Which of the following is the most
likely diagnosis?
A. Acoustic neuroma
B. Astrocytoma in the cerebellum
C. Craniopharyngioma
D. Parasagittal meningioma
E. Pinealoma
mosaabma - 10-24-06 15:23
A 50-year-old woman who works as a paralegal in a law firm comes to her local doctor because of
problems with sleep. The patient says that over the past several weeks, she hasn't slept well, feels
tired, and has had headaches. She does not smoke or drink alcohol, except on special occasions,
and does not take any medications. The patient's pupils are 5 mm in size, equal and reactive,
with both the direct and consensual light reflexes intact. Accommodation is unimpaired.
Examination of the visual fields and funduscopy are unremarkable. Extraocular movements reveal
normal conjugate, oblique, and downward movement, but she is unable to look upwards. No other
abnormalities are found on the neurological examination. Which of the following is the most
likely diagnosis?
A. Acoustic neuroma
B. Astrocytoma in the cerebellum
C. Craniopharyngioma
D. Parasagittal meningioma
E. Pinealoma
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#1
Re: Pathology 21 nrp - 10-27-06 11:51 E.Pinealoma. The syndrome is known as Parinaud's syndrome characterized by upward gaze palsy,Pseudoargyl robertson pupil, see saw nystagmus nd retraction of eye lids
#2
Re: Pathology 21
mosaabma - 10-27-06 12:08 The correct answer is E. This patient has a pinealoma. Tumors of the pineal gland compress the vertical gaze center in the tectum of the midbrain. The pineal gland manufactures melatonin
from its precursor serotonin; an inadequate supply of melatonin results in insomnia. Tumors of
the pineal gland will not compress the cerebral cortex or the rest of the brainstem.
Frequently, the only physical sign noted is failure of upward gaze.
An acoustic neuroma (choice A) is a schwannoma of the eighth cranial nerve. It results in deafness, ataxia, and dysarthria. Nystagmus may be present. The gaze centers are not affected.
Astrocytomas of the cerebellum (choice B) are usually seen in children. These tumors present with headache, nausea, vomiting, papilledema, and cerebellar signs such as ataxia, dysarthria, nystagmus, and intention tremor. The gaze centers are not affected.
Craniopharyngiomas (choice C) are usually seen in children. There is failure of growth, headaches, and bitemporal hemianopia.
Parasagittal meningiomas (choice D) usually result in headache, spastic paresis, and urinary incontinence.
#3
Re: Pathology 21 galaxy - 05-27-10 19:29 impaired upward gaze, abseent accomodation refex are seen due to the compression effects of the pinealoma on the midbrain....
#4
Re: Pathology 21 babbu5508 - 06-21-10 15:05 E. Pinealoma.. pineal gland produces the hormone melatonin which plays a role in regulating circadian rhythms. A pinealoma may disrupt production of this hormone, and insomnia may result.
#5
Re: Pathology 21 bingousmle - 06-30-10 22:20 Parinaud's syndrome characterized by upward gaze palsy,Pseudoargyl robertson pupil, see saw nystagmus nd retraction of eye lids
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