Basic Human Neuroanatomy
A Clinically Oriented Atlas 
Case 22 Answers

1.  Do you think that the patient's 50 year history of headache is related to his present neurologic condition?

No – chronic tension-type headache

2.  What is the significance of the recent onset over 2 to 3 months of increasing headache, dizziness, frequent nausea and vomiting, and loss of consciousness?  Do these indicate involvement in a localized area of the brain or some other process?  If the latter is true, what type of process is involved?

Increased intracranial pressure.  This is a diffuse process.

3.  What is the localizing significance of the findings on neurologic examination; especially those having to do with gait and stance?

Midline cerebellar syndrome with intact limb coordination, but impaired gait and stance.

4.  What area of the nervous system is involved by the pathologic process?  Which side of the nervous system is involved?

Cerebellar vermis.  Midline.

5.  In general, 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), cerebellar paraneoplastic syndrome. 
Vascular process seems less likely.

6.  What is the most likely pathologic diagnosis?

Metastatic lung cancer to the vermis of the cerebellum

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

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