43

43 CASE 43


An 8-year-old boy is brought by his parents to the pediatrician because of an increasing pattern of clumsiness and headaches.


The parents have noted that the child is having difficulty in grabbing or picking up objects, such as crayons, with his right hand. His ability to draw lines is greatly diminished. The child’s teacher first brought this to the parents’ attention 3 weeks ago, and it has been getting progressively worse. During the past 4 days, the child has been complaining of headaches. The child has been properly immunized and has reached all developmental milestones.



PHYSICAL EXAMINATION



VS: T 37°C, P 85/min, R 20/min, BP 95/80 mm Hg

PE: Some swelling of the optic nerve observed by funduscope but no visual disturbances. An intention tremor is present when moving the right hand to pick up an object. There is no tremor at rest, and moving the left hand to pick up an object does not generate an intention tremor. Muscle strength is not diminished. Romberg test is negative.


LABORATORY STUDIES



MRI: Laterally located cyst at the junction of the vermis and hemisphere of the middle lobe of the right cerebellum


DIAGNOSIS


Astrocytoma of the vermis of the cerebellum



PATHOPHYSIOLOGY OF KEY SYMPTOMS


The patient shows a deterioration of both fine and gross motor skills. This observation, combined with a headache, suggests a defect within the central nervous system areas involved in motor control. The primary regions controlling motor activity are the motor areas of the cortex, the basal ganglia, and the cerebellum.


Cerebellum, or “little brain,” is a large collection of nuclei that coordinate and control motor activity. Functionally, the cerebellum can be divided into three regions: the vestibulocerebellum, the spinocerebellum, and the cerebrocerebellum (Fig. 43-1).


image

FIGURE 43–1 The subdivision of the cerebellum into archicerebellum, paleocerebellum, and neocerebellum is shown by the black, hatched, and gray areas. Terminations of vestibulocerebellar fibers are indicated by the large dots, spinocerebellar fibers by the open circles, and pontocerebellar fibers by the small dots.


(Redrawn from Brodal A: Neurological Anatomy, 3rd ed. New York, Oxford University Press, 1981.)

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Jul 4, 2016 | Posted by in PHYSIOLOGY | Comments Off on 43

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