Case 183 Answers

Basic Human Neuroanatomy

A Clinically Oriented Atlas

Case 183 Answers

1. Do you think that this patient’s headache problem is due to a serious or structural problem or a more benign process? Cite the evidence in support of your conclusions.

Structural basis. Recent onset, progressive headache, increased headache with valsalva maneuver, unusual head position.

2. How would you characterize or classify this patient’s headache problem?

Intracranial traction headache due to a space occupying lesion (SOL)

3. What do the findings on funduscopic examination suggest? What is the significance of these findings?

Mild, early papilledema in OD. Increased intracranial pressure (ICP).

4. Considering this patient’s history and examination, how precisely can the neurologic lesion be localized in this case?

Not very precisely. Symptoms are mainly those of increased intracranial pressure.

5. Indicate the level of the neurologic lesion in this case as precisely as possible and the structures involved by the pathologic process. If precise localization is not possible, list as many levels or structures as you can that might produce the same clinical picture, if involved by the pathologic process.

Increased ICP, perhaps due to hydrocephalus (??), perhaps due to a posterior fossa SOL because of the short history and no localizing signs. The posterior location of the headache and the neck posturing might suggest a foramen magnum SOL.

6. In general, what type of pathologic process do you think is involved in this case? What other considerations would be in this patient’s differential diagnosis?

Neoplastic – Medulloblastoma. Arnold-Chiari malformation, foramen magnum meningioma or other SOL, aqueductal stenosis, basilar meningitis could be other possibilities.

7. What diagnostic procedure(s) would you undertake at this point?

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