Clinicopathological conference pediatrics
This presentation is the property of its rightful owner.
Sponsored Links
1 / 20

CLINICOPATHOLOGICAL CONFERENCE PEDIATRICS PowerPoint PPT Presentation


  • 82 Views
  • Uploaded on
  • Presentation posted in: General

CLINICOPATHOLOGICAL CONFERENCE PEDIATRICS. Durante, Esperon, Espino, Fernando, Figuracion, Flores, Fong, Francisco, Francisco, Garcia, Garcia, Garcia, Garcia, Garcia, Garimbao . SUBJECTIVE. 10-year-old intermittent headache of 1 year duration vague frontal headaches

Download Presentation

CLINICOPATHOLOGICAL CONFERENCE PEDIATRICS

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Clinicopathological conference pediatrics

CLINICOPATHOLOGICAL CONFERENCE PEDIATRICS

Durante, Esperon, Espino, Fernando, Figuracion, Flores, Fong, Francisco, Francisco, Garcia, Garcia, Garcia, Garcia, Garcia, Garimbao


Subjective

SUBJECTIVE

  • 10-year-old

  • intermittent headache of 1 year duration

    • vague frontal headaches

    • occur twice a week, usually in the late afternoons

  • diagnosed to have Iron Deficiency Anemia

  • prescribed with oral Iron preparation


Subjective1

SUBJECTIVE

  • projectile vomiting

    • non-villous, non-bloody

    • amounting to half a cup

    • occurs 2-3 times a day

  • did not experience tinnitus, gait disturbance, gastrointestinal, and urinary problems


Subjective2

SUBJECTIVE

  • allergic to shrimp

  • diagnosed with asthma last 2007

  • family history of diabetes mellitus and hypertension


Objective

OBJECTIVE

  • slightly pale conjunctivae

  • + horizontal nystagmus

  • GCS 15 (E4V5M6)

  • positive for Romberg’s sign

  • no motor or sensory deficit

  • negative for Babinski sign, ankle clonus, nuchal rigidity, Kernig’s sign, and Brudzinski sign


Course in the wards

COURSE IN THE WARDS

  • Admission

  • given Omeprazole 40 mg IV OD

    • to prevent irritation of the esophageal mucosa due to multiple bouts of vomiting

  • Ist HOSPITAL DAY

  • given Dexamethasone 2.5mg q6h

    • for the treatment of vasogenic edema associated with brain tumors

  • given Mannitol at 100 cc q6h

    • to decrease intracranial volume


Course in the wards1

COURSE IN THE WARDS

  • CSF analysis from ventricular drainage

    • 5 cc of clear, colorless fluid

    • pH of 7.5

    • specific gravity of 1.010

    • RBC 514 x 106

    • WBC 1 x 106, 100% lymphocytes

    • glucose of 4.7 mmol/L

    • protein 0.11 g/L

    • (-) Pandy’s


Course in the wards2

COURSE IN THE WARDS

  • 4TH HOSPITAL DAY

    • the patient underwent an operation

    • Ceftriaxone 750 mg IV was started and other medications were continued

  • 6th HOSPITAL DAY

    • Limited lateral eye movements on the left


Course in the wards3

COURSE IN THE WARDS

  • 7TH HOSPITAL DAY

  • Omeprazole IV and Dexamethasone IV were shifted to oral preparation

    • no episodes of vomiting were noted

  • MRI of the whole spine and liver function test

    • to evaluate for possible metastasis


Primary impression medulloblastoma

PRIMARY IMPRESSION:MEDULLOBLASTOMA

  • Primarily considered due to:

  • Results of the patient’s CT scan (hyperdense lesion in the cerebellar vermis)

    • most common malignant hyperdense brain tumor arising in the cerebellar vermis

  • The patient’s age (10 y/o)

    • usually seen in 0-14 years of age


Primary impression medulloblastoma1

PRIMARY IMPRESSION:MEDULLOBLASTOMA

  • Presenting signs and symptoms

    • vague headache

    • vomiting

    • (+) Romberg sign

    • cranial nerve deficits


Primary impression medulloblastoma2

PRIMARY IMPRESSION:MEDULLOBLASTOMA

  • Incidence

    • accounts for 90% of embryonal tumors

    • 2% of all primary brain tumors

    • 18% of all pediatric brain tumors

    • predominately in males

    • majority occur in the midline cerebellar vermis


Primary impression medulloblastoma3

PRIMARY IMPRESSION:MEDULLOBLASTOMA

  • Signs and Symptoms

    • signs and symptoms of increased intracranial pressure and;

      • headache, nausea, vomiting, mental status changes, and hypertension

    • cerebellar dysfunction

      • ataxia, poor balance, dysmetria


Primary impression medulloblastoma4

PRIMARY IMPRESSION:MEDULLOBLASTOMA

  • Etiology and Pathogenesis

    • occur in the posterior fossa

    • 30–40% = chromosome 17p deletions

    • 10–20% = genetic loses on chromosomes 1q and 10p

    • 10% = abnormalities of chromosome 9p

    • arises from cerebellar stem cells

      • perivascular pseudorosette and Homer-Wright rosette formation


Differential diagnosis ependymomas

DIFFERENTIAL DIAGNOSIS:EPENDYMOMAS


Differential diagnosis hemangioblastoma

DIFFERENTIAL DIAGNOSIS:HEMANGIOBLASTOMA


Differential diagnosis cryptococcoma

DIFFERENTIAL DIAGNOSIS:CRYPTOCOCCOMA


Plan diagnostic procedures

PLAN:Diagnostic Procedures

  • Laboratory studies

    • CBC, lectrolytes and liver and renal function tests

  • Imaging studies

    • CT scan, MRI, and bone scan

  • Other procedures

    • audiography or brainstem auditory-evoked response,

    • lumbar Puncture

    • bone marrow aspirate

    • biopsy and histologic study of the specimen


Plan treatment

PLAN:Treatment

  • Surgery

    • to relieve cerebrospinal fluid buildup

    • to confirm the diagnosis by obtaining a tissue sample

    • to remove as much tumor as possible

  • Glucocorticoid treatment

    • to decrease the volume of edema surrounding brain tumors


Plan treatment1

PLAN:Treatment

  • ventriculostomy

    • to divert excess cerebrospinal fluid from the brain

  • radiation therapy

    • to reduce the number of left-over cells


  • Login