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Old 03-10-2012
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Neuro Unsteady gait, facial weakness, and hyperreflexia!

An irritable 6-year-old child has a somewhat unsteady but nonspecific gait. Physical examination reveals a very mild left facial weakness, brisk stretch reflexes in all four extremities, bilateral extensor plantar responses (Babinski reflex), and mild hypertonicity of the left upper and lower extremities; there is no muscular weakness.
Which of the following is the most likely diagnosis?

a. Pontine glioma
b. Cerebellar astrocytoma
c. Tumor of the right cerebral hemisphere
d. Subacute sclerosing panencephalitis
e. Progressive multifocal leukoencephalopathy
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Old 03-10-2012
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(Behrman, 16/e, pp 18581862. McMillan, 3/e, pp
15111515. Rudolph, 21/e, pp 22192221.)
A is correct answer
A child who has a subacute disorder of the central nervous system that produces cranial nerve abnormalities (especially of cranial nerve VII and the lower bulbar nerves), long-tract signs, unsteady gait secondary to spasticity, and some behavioral changes is most likely to have a pontine glioma. Tumors of the cerebellar hemispheres can, in later stages, produce upper motor neuron signs, but the gait disturbance would be ataxia. Dysmetria and nystagmus also would be present. Supratentorial tumors are quite uncommon in 6-year-old children; headache and vomiting would be likely presenting symptoms and papilledema a finding on physical examination.
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Nervous-System-, Neuroanatomy-, Pathology-, Step-1-Questions

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