#NeurologyMorningReport Case 43 #MedTwitter Updates & Answers posted later today. Asking your help #MedEd #neurology #neurologyresident #neurologist #medstudent #NeurologyProud #IamaNeurologist Join me in educating. Share your questions and knowledge.

1/

65 yo man h/o diabetes p/w progressive dysphagia, diplopia, &dysarthria x3m.

Thinking fast- show your biases- what's 1st diagnosis that comes to mind given this history? If you want to be anonymous respond via polleverywhere (no-spaces-between-words) -word cloud later today

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Initially, he described fluctuating symptoms and as part of w/u for MG, had CT scan of the chest.

CT showed multiple osteolytic & blastic lesions in vertebral bodies and ribs.

More history revealed weight loss and fatigue over months.

PE: representative video and images
3/

Abnormalities on exam shown in video and below drawing and image (from another pt).

Mental status and neuro exam below the neck were normal.

4/

Where do you localize the lesion?

Great tweetorial by @AaronLBerkowitz on brainstem anatomy and cranial nerves https://threadreaderapp.com/thread/1265051075431690240.html

Please add other resources you recommend for learning about significance of this patient's findings.

5/

Video shows bilateral abducens palsies (B CN VI)
Drawing shows L palate weakness (L CN X)
Image shows L tongue atrophy (L CN XII). The involvement of the eye movements means that it cannot only localize to the medulla.

6/

MRI brain shows infiltrating destructive and enhancing lesion at skull base/clivus

7/

PET shows multiple bony lesions

LP is normal. Negative cytology.

8/

PSA makedly elevated. Bx shows:

Dx: #ProstateCancer with #SkullBaseMetastases #MultipleCranialNeuropathies #GodtfredsenSyndrome

Other examples:
https://www.sciencedirect.com/science/article/abs/pii/S152918390600697X

https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.20553 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3212593/