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Spinal tumour with raised intracranial pressure
  1. S K G Samson,
  2. T P Joseph,
  3. T Solomon,
  4. R T Daniel,
  5. C Gnanamuthu
  1. Department of Neurological Sciences, Christian Medical College and Hospital, Vellore, TN 632004, India
  1. Correspondence to:
 Dr Samson;
 gsskcmc{at}yahoo.com

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Answers on p 632.

A 13 year old girl presented with symptoms of headache, vomiting, diplopia, low backpain with radiating pain into the right leg, weakness, and sensory loss in the right leg of two months’ duration. These symptoms were progressively worsening. There was no involvement of bowel and bladder and no history of fever or seizures.

On examination she had bilateral papilloedema and bilateral lateral rectus palsy. Other cranial nerves were normal. Neurological examination in the arms was normal. There was wasting of the right thigh and right leg. The muscle power was grade 4 at right hip and knee and grade 3 at the right ankle. The sensations in right L5–S1 dermatomes were diminished. The right knee and ankle deep tendon reflexes were absent. The plantar response was bilaterally flexor. There were no cerebellar signs. Cranial magnetic resonance imaging showed no cause for raised intracranial pressure and a normal ventricular system.

QUESTIONS

  1. Based on history and clinical examination what is the differential diagnosis?

  2. What are the investigations required?

  3. What are the causes of bilateral papilloedema without an expanding intracranial mass lesion?

  4. What are the mechanisms/processes which lead to raised intracranial pressure in patients without intracranial mass lesions?

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