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Review Question - QID 212324

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QID 212324 (Type "212324" in App Search)
A 12-year-old boy is brought to his primary care physician because he has been tripping and falling frequently over the past 2 months. He says that he feels like he loses his balance easily and finds it difficult to walk in tight spaces such as his school hallways. Furthermore, he says that he has been experiencing insomnia over the same time period. His past medical history is significant for some mild allergies, but otherwise he has been healthy. Physical exam reveals that his eyes are fixed downwards with nystagmus bilaterally. Which of the following structures is most likely affected by this patient's condition?

4th ventricle

7%

2/30

Cerebellum

43%

13/30

Pineal gland

43%

13/30

Pituitary gland

3%

1/30

Thalamus

3%

1/30

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This patient with ataxia, insomnia, downward gaze, and nystagmus most likely has Parinaud syndrome, which is associated with a tumor of the pineal gland.

Parinaud syndrome is a cluster of eye movement abnormalities that is characterized by paralysis of upward gaze, nystagmus, and eyelid retraction. This combination of abnormalities results in conjugate downward gaze, which is also referred to as the "setting-sun" sign. The cause of these eye movement defects is compression of the vertical gaze center in the mesencephalic tectum, which in young patients primarily occurs due to tumors of the pineal gland region. Other symptoms of pinealomas include insomnia as well as ataxia.

Incorrect Answers:
Answer 1: Compression of the 4th ventricle can lead to hydrocephalus; however, this would not lead to the "setting-sun" sign.

Answer 2: Compression of the cerebellum can lead to ataxia and nystagmus; however, this would not lead to the "setting-sun" sign.

Answer 4: Compression of the pituitary gland can lead to insomnia; however, this would not lead to the "setting-sun" sign.

Answer 5: Compression of the thalamus can lead to ataxia; however, this would not lead to the "setting-sun" sign.

Bullet Summary:
Parinaud syndrome presents with conjugate downward gaze also known as the "setting-sun" sign.

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