Thursday, March 27, 2014

Descartes' Soul

An 8 year old boy presents with slow onset, gradually progressive headaches and lethargy. This is accompanied by vision changes, nausea, vomiting, and most recently, impaired ambulation. His exam shows papilledema, ataxia, and loss of upward gaze. In fact, he has a downward gaze preference. Convergence and divergence are impaired, and bilateral ptosis is noted.

Imaging shows the following:
Challenge: What's your diagnosis?

Image shown under Fair Use.

1 comment:

Craig Chen said...

Descartes’ Soul

This is a pineal gland tumor. The eye findings are consistent with Parinaud syndrome from pressure on the pretectal region (dorsal aspect of the rostral or upper midbrain). Descartes believed the pineal gland to be the seat of the soul.

Sources: UpToDate; neurosurgery.ucla.edu.