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Old 05-09-2011
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Neuro Patient with Neurologic lesions and positive VDRL

34 year old man with a history of high risk sexual activity, comes to your clinic with complaints of inability to abduct the eye as well as horizontal diplopia. P/E reveals abnormal pupillary reflex (only responds to accommodation, not to light). Vitals include BP 128/80, 12 RR, Temp 36.6 degrees. Lab Investigations: VDRL and FTA ABS, which both come back positive.

What is the most likely cause?

A) Cranial Nerve VI paralysis
B) Primary Meningioma
C) Oligodendroglioma
D) Pituitary Tumor
E) Ependymomas

Its my first time making a question, excuse me for any mistakes

Last edited by patelMD; 05-10-2011 at 12:08 AM.
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Old 05-10-2011
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Do you mean corneal reflex or pupil reflex?
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Old 05-10-2011
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Probably CN 6th palsy/also internuclear neurons that project (via MLF) to medial rectus subdivision of contralateral oculomotor (CN III) nucleus (ie lesion of nucleus causes ipsilateral horizontal gaze palsy)

Would go with A.
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I think it's A, too. CN VI palsy causes horizontal diplopia.

Tumors are slow growing so the symptoms must be gradual and progressive. There will also be symptoms of increased ICP. Pituitary tumor... should have endocrine problems, and bitemporal hemianopsia if it compresses the optic chiasm. Ependymoma... should have hydrocephalus.
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Old 05-10-2011
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me also thnk its a
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I think this is called Argyll Robertson pupils or light-near dissociation (Pupils responds to accommodation and don't react to light), which is associated with neurosyphilis ( + VDRL and FTA ABS) , so as neurosyphilis is not in the answers i would weekly go with (A), a neurosyphilis lesion causes CN VI palsy and Argyll Robertson pupils as well.
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Old 05-10-2011
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yea, i say a too
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Default Answer is A

Quote:
Originally Posted by Abdulhakeem View Post
I think this is called Argyll Robertson pupils or light-near dissociation (Pupils responds to accommodation and don't react to light), which is associated with neurosyphilis ( + VDRL and FTA ABS) , so as neurosyphilis is not in the answers i would weekly go with (A), a neurosyphilis lesion causes CN VI palsy and Argyll Robertson pupils as well.
Perfectly explained!

The answer is A!

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