1. How would you describe this patient’s visual
findings?
Right
homonymous
hemianopsia
2. Concerning her visual symptoms, indicate the specific
structures involved in producing these signs and symptoms. Is
there only one anatomical location that can produce these visual signs
and symptoms? If so, what is that location? If not,
what are the possible locations of such a lesion?
1.
Left
optic radiations in the occipital lobe, involving the cuneus and
lingual gyrus (upper and lower banks of the
calcarine sulcus, respectively).
2. Left
optic tract.
3. Left
lateral geniculate body and the adjacent retrolentiform part of
the
internal
capsule.
(See
slides #1 and 2)
3. Considering her entire history and examination, what type
of pathologic process do you think is involved in this case?
Subacute
process with some progression raises the possibility of a
primary
or metastatic brain tumor, infectious disorder with some focal
features
(abscess, tuberculoma, cryptococcoma), other localized or multifocal
process. Vascular process seems less likely, unless diffuse
or multifocal processes
such as vasculitis or septic emboli were present.
4.
What is the most likely pathologic diagnosis?
Metastatic
non-small cell
carcinoma of the lung
5. What diagnostic procedure(s) would you undertake at this
point?
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