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Chapter 19. Brain Tumors and Hydrocephalus

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A 46-year-old man who has been suffering from worsening headaches over the past 1 to 2 weeks now presents with severe nausea and vomiting. His friend also notices that he has relatively significant gait imbalance. He is brought to the emergency department (ED) where a stat head computed tomography (CT) is performed and is shown below.

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Image not available.

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Computed tomography (CT) of the head, axial view, shows signs of severe asymmetric hydrocephalus with unilateral dilatation of the left-sided lateral ventricle.

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Based on this CT scan, what is the most likely diagnosis?

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A. Obstructive mass at the level of the cerebral aqueduct

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B. Intraventricular hemorrhage from the left-sided basal ganglia

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C. Obstructive mass at the level of the foramen of Monro

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D. Subarachnoid hemorrhage from a vascular lesion

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E. Basilar meningitis

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C. The CT scan shows severe asymmetric hydrocephalus with unilateral dilatation of the left-sided lateral ventricle. This is most consistent with obstruction at the level of the foramen of Monro. A mass situated at the cerebral aqueduct or fourth ventricle would cause symmetric dilatation of the lateral and third ventricles. In addition, there is a mass lesion located within the third ventricle as seen on the second CT slice. There is no evidence of hemorrhage in the ventricles, which can be a mechanism for asymmetric hydrocephalus, and there is also no subarachnoid hemorrhage. Basilar meningitis, although partially consistent with the presentation, would also cause diffuse hydrocephalus.

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A 46-year-old man who has been suffering from worsening headaches over the past 1 to 2 weeks now presents with severe nausea and vomiting. His friend also notices that he has relatively significant gait imbalance. He is brought to the emergency department (ED) where a stat head computed tomography (CT) is performed and is shown below.

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Image not available.

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Computed tomography (CT) of the head, axial view, shows signs of severe asymmetric hydrocephalus with unilateral dilatation of the left-sided lateral ventricle.

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After reviewing the CT scan, you recognize that there is a likely mass situated at the foramen of Monro. Clinically, the patient becomes noticeably more confused and then lethargic. His vital signs are stable, and he is protecting his airway. What is the next best step in management?

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A. Stat magnetic resonance imaging (MRI) to better evaluate the mass for operative planning

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B. Placement of bifrontal external ventricular drains for hydrocephalus treatment

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C. Placement of a left frontal external ventricular drain for hydrocephalus ...

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