(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

A 49 year old female presented to the hospital with nausea and vomiting. CT scan of the abdomen demonstrated gastric and duodenal masses and retroperitoneal lymphadenopathy. She underwent retroperitoneal lymph node, gastric body, gastric antrum and duodenal biopsies.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

A 49-year old man presented with chief complaints of stuffy nose, worsening headache for the past 3 weeks and binocular diplopia which developed over a period of 4 days. Significant past medical history included hypertension and a biopsy performed from a right chest wall mass, approximately 1 year ago. Pathology report was not available at the time of presentation. General physical examination was unremarkable and neurological examination revealed signs of bilateral sixth nerve palsy.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

Patient is a 49 year old male who does not have a significant past medical history until he developed tooth pain. He was found to have tooth abscesses which were treated with antibiotics. A month later, he had his wisdom teeth pulled and experienced delayed healing and persistent pain. He then began to feel fatigued, weak, and dyspnea on exertion, prompting a visit to his primary care doctor. Laboratory studies revealed pancytopenia resulting in a bone marrow biopsy.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

A 44-year-old man with a four-year history of progressive neuropsychiatric symptoms, including irritability, apathy and hyposexuality, was admitted to another hospital because of increasing impairment of executive functions, delusions, paranoid ideation and mild cognitive decline. Physical and laboratory examinations were normal. An EEG study showed focal theta activity over the right frontal areas, whereas a brain MRI revealed mild cortical atrophy of the right hemisphere.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

A 49-year-old man presented with fever and altered mental status. He had a complex prior medical history notable for type I diabetes mellitus with end-stage renal disease and peripheral vascular disease. Eight years prior to admission he underwent pancreatic and renal transplantation secondary to diabetes. The renal transplantation procedure was initially complicated by intra-operative myocardial infarction, and subsequently by acute and chronic allograft rejection. Consequently, the patient had been on long-term immunosuppressive therapy. He also suffered from chronic atrial fibrillation requiring warfarin and had undergone cardiac valve replacement one year earlier.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

A family member had gone to pick up this 49 year old, white female, from her apartment for a family dinner and found her unresponsive in bed, wearing her blue pajamas. Scene investigation revealed multiple, randomly situated medication bottles around the apartment, some with the lids off. Some of the bottles were empty and others contained the following prescribed pills: Desipramine, Imipramine and Fluoxetine. The prescriptions had been filled two days prior and a significant number of pills were unaccounted for. There was no scene evidence of any struggle or any signs of violence. There was a strong family and personal history of long standing depression. She was under psychiatric treatment and attended several support groups for the depressed. She had mentioned an intention to commit suicide four years prior, but there was no recent mention or suggestion of suicide. She seemed stable and responded well to therapy. There was no history of any previous suicide attempt (para-suicide). No suicide note was found at the apartment.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

A 49 year old woman with a remote history of borderline serous tumor of the right ovary presented with a history of headache, nausea and vomiting. MRI imaging of the brain showed mixed solid and cystic pineal region mass causing obstruction at the level of the cerebral aqueduct associated with marked hydrocephalus (Fig. 1). The patient underwent a third ventriculostomy and pineal region tumor biopsy.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

A 4-year-old girl presented with right hemiparesis and ataxia. Her symptoms progressed rapidly and she could no longer ambulate without assistance. Her exam was remarkable for severe right-sided weakness of both upper and lower extremities. The MRI showed a left thalamic, hemorrhagic mass measuring up to 42 x 33 x 38 mm (Figs. 1a, 1b). Mass effect on the third ventricle was noted with resultant acute obstructive hydrocephalus. Interval placement of an EVD at the time of presentation helped mildly improve ventricle size. Gross total resection was performed by a parietal craniotomy and inner hemispheric, transcallosal approach.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

The patient is a 5 month old male born to a G2P1 mother at 36 weeks gestation by Cesarean section. The infant was discharged home on day 4 of life.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

The patient is a 4 week-old male infant born at 41 weeks gestation via Cesarean section to a 26 year-old mother who received good prenatal care. Prenatal ultrasounds performed at 20 weeks and 40 weeks gestational age were unremarkable. The delivery was uneventful. On physical exam in the newborn nursery the baby was noted to have right cryptorchidism and a palpable right-sided abdominal mass.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

Following an unremarkable prenatal course, a full-term male was floppy at birth and experienced respiratory difficulty. By one month of age, decreased proximal shoulder tone and head lag were apparent. Despite physical therapy, gross motor skills lagged. By 20 months of age, an EMG showed decreased activation of motor units. The patient walked with flat arches and an awkward gait and had bilateral ptosis. Reflexes were difficult to elicit. At the age of four, he developed dilated cardiomyopathy with an ejection fraction as low as 10%. Heart transplantation was performed.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

This 4-year-old girl presented to the emergency department complaining of fever and pain in the lower extremities with refusal to bear weight. On four occasions a hip x-ray was performed, and she was sent home with pain medications. No laboratory studies were performed. She presented again with the above symptoms and weight loss (weight 13.8 kg, <10th percentile for age.) She was admitted and worked up for possible malignancy. Laboratory studies including a bone marrow biopsy were performed.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

A 4-month-old female infant presented with a growing extracranial mass at the left frontotemporal region. Covered with intact skin, the lesion measured 3.5 x 3 x 3 cm; it was well-defined, bony hard in consistency, and fixed to the underlying skull. There were no other abnormal symptoms, and routine laboratory tests were within normal limits. The mass appeared sclerotic on skull film. Computerized tomography scan of the brain (Fig. 1) showed a homogeneously enhancing expansile bone tumor. The lesion caused widening of the lower part of the left coronal suture, just above the orbital roof. The patient underwent left frontotemporal craniotomy, and the mass was found to involve the frontal and temporal bones, around the inferior limb of the coronal suture, adherent to the underlying dura. The orbital roof and apex were also affected. The lesion was totally resected. The immediate postoperative course was uneventful.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

A 50-year old male with a history of type 2 diabetes, hypertension and a nontoxic goiter, was referred to a neurosurgical center due to a newly diagnosed hypothalamic mass. He had been previously admitted to his local hospital due to somnolence, inadequate behaviour and memory disturbances of about two-week duration. His blood glucose levels were regularly measured and were known to be normal through the preceeding weeks. A full endocrinologic check-up showed normal levels of all measured hormones and no alteration of their circadian rhythms.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

A 50-year-old man was followed for 4 years for a radiological diagnosis of meningiomas of the falx cerebri. He was admitted for an evaluation of the mass that had slightly increased in the last year prior to this presentation. General examination disclosed nothing. Computed tomography showed a large hypodense well-circumscribed mass attached by a broad base to the falx cerebri (Figure 1a). On MRI of the head, the tumor measured 3.5 cm and appeared hypointense on T1-weighted images and hyperintense on T2-weighted images. It was uniformly enhanced by Gadolinium contrast injection (Figure 1b) and hyperinstense on T2-Flair (Figure 1c). There was no parenchymal abnormality. The radiologist interpreted the imaging as suspicious for a meningioma. Due to the recent enlargement of the tumor, a total resection was performed. Intra-operatively, the lesion was defined by the surgeon as a lesion with a dural-based attachment suggesting a meningioma.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

A 50-year old Caucasian female patient presented for follow up in February 2007, several months after a left tympanomastoidectomy (July 2006) with ongoing complaints of fullness, fluttering, and hearing loss in her left ear. In June 2007, an MRI of the internal auditory canals was performed and incidentally suggested a pituitary mass. A dedicated pituitary MRI was repeated in July 2007 and showed a well-circumscribed 8mm area of less-enhancing tissue within the left pituitary (arrow, Figure 1) without obvious invasion of the cavernous sinuses or impingement on the optic chiasm.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

A 50-year-old female with no significant surgical history presented with a left posterior thigh mass. Magnetic resonance imaging studies demonstrated a 3.0 cm peripherally enhancing, lobulated mass that was centered in the subcutaneous tissue of the left distal thigh.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

The patient was a 50-year-old man who presented with six months of abdominal pain, a 15-20 pound weight loss, night sweats and chills. Biopsies of the stomach revealed Burkitt lymphoma with retroperitoneal involvement. A staging bone marrow biopsy was negative for tumor. However, tumor burden was large and chemotherapy was elected. Cyclophosphamide and prednisone were given prior to the start of a chemotherapy regimen consisting of ifosfamide, mesna, methotrexate, leucovorin, vincristine, Ara-C, etoposide and Decadron. Intrathecal methotrexate was given twice. The patient developed fevers shortly before completion of this protocol. Pan-cultures remained negative. The patient tolerated chemotherapy until the final day (7 days after the last intrathecal dose of methotrexate) when he became confused. Over the following day this evolved into an agitated delirium. Neurologic exam later that day showed decerebrate posturing in an intubated, comatose patient with intact brainstem function. Head CT showed no evidence of hemorrhage and MRI showed minimal findings on diffusion and FLAIR images. EEG showed changes suggestive of drug effect but no significant focal abnormalities. CSF showed normal glucose and protein levels and no white blood cells. Clinically, the patient failed to improve over the next three days. MRI imaging studies were repeated and showed severe changes. The patient expired 12 days after symptom onset.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

A 50-year-old man with a two-month history of severe back pain being treated for shingles complained of mild headaches and sudden-onset diplopia for two weeks. His medical history is significant only for heavy alcohol use. Neurologic examination revealed ptosis and complete plegia of his right eye. The remainder of the exam was within normal limits. MRI revealed a 3.0 x 2.9 x 1.5 cm circumscribed mass centered on the sella turcica extending into the superior aspect of the clivus and into the right cavernous sinus. It demonstrated mild, somewhat heterogeneous enhancement with intermediate signal intensity on T1 and was isointense on T2-weighted images (Figures 1 and 2). No normal pituitary gland was identified. Serum prolactin, follicle stimulating hormone and growth hormone levels were within normal limits.

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

A 50 year old lady presented to the clinic with mild occipital headaches, vomiting, swallowing difficulties and ataxia which had developed over a period of 3 months and were progressively worsening in severity. No significant past medical history was noted and she was not on any regular medication. The social and family histories were unremarkable. Examination demonstrated a GCS 15/15, horizontal nystagmus, intention tremor and disdiadokokinesis. Fundoscopy revealed bilateral papilloedema. No cranial nerve dysfunction was identified. MR imaging revealed a 4th ventricular enhancing mass with significant obstructive hydrocephalus and a degree of tonsillar herniation (Fig 1).