Germinoma physical examination: Difference between revisions
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{{CMG}}{{AE}}{{Simrat}} | {{CMG}}{{AE}}{{Simrat}} | ||
==Overview== | ==Overview== | ||
Common physical examination findings of germinoma include paralysis of upward gaze, pupils nonreactive to light perception and accommodation or pupils which react better to accommodation than light, [[nystagmus]], failure of convergence, lid retraction, [[papilledema]], [[ataxia]], and neurologic examination may be abnormal depending on the location of the tumor. | |||
==Physical Examination== | ==Physical Examination== | ||
The clinical evaluation for germ cell tumors should include the following: | The clinical evaluation for germ cell tumors should include the following:<ref name="NCI"> Germ cell tumors. National Cancer Institute(2015) http://www.cancer.gov/types/brain/hp/child-cns-germ-cell-treatment-pdq#link/_60_toc Accessed on February 16, 2016</ref> | ||
*General physical examination | *General physical examination | ||
*Check of growth parameters | *Check of growth parameters | ||
*Careful neurological evaluation | *Careful neurological evaluation | ||
*Assessment of primary and secondary sexual characteristics | *Assessment of primary and secondary sexual characteristics | ||
*Ophthalmological exam | *[[Ophthalmological]] exam | ||
Radiographic characteristics of CNS germ cell tumors GCTs cannot reliably differentiate germinomas from nongerminomatous germ cell tumors NGGCTs. The diagnosis of GCTs is based on the following: | Radiographic characteristics of CNS germ cell tumors GCTs cannot reliably differentiate germinomas from nongerminomatous germ cell tumors NGGCTs. The diagnosis of GCTs is based on the following: | ||
*Clinical signs and symptoms | *Clinical signs and symptoms | ||
*Tumor markers (Alpha-fetoprotein (AFP) and beta subunit human chorionic gonadotropin (beta-HCG) in both serum and CSF, lumbar CSF cytology) | *Tumor markers ([[Alpha-fetoprotein]] (AFP) and [[beta subunit human chorionic gonadotropin]] (beta-HCG) in both serum and CSF, lumbar CSF cytology) | ||
*Neuroimaging | *[[Neuroimaging]] | ||
*Cytological cerebrospinal fluid (CSF) and histological confirmation | *Cytological cerebrospinal fluid ([[CSF]]) and histological confirmation | ||
*Magnetic resonance imaging (MRI) of brain and spine with gadolinium | *[[Magnetic resonance imaging]] (MRI) of [[brain]] and [[spine]] with gadolinium | ||
*Evaluation of pituitary/hypothalamic function | *Evaluation of [[pituitary]]/[[hypothalamic]] function | ||
*Visual-field examinations for suprasellar or hypothalamic tumors | *Visual-field examinations for suprasellar or hypothalamic tumors | ||
*A baseline neuropsychological examination when symptoms of endocrine deficiency and raised intracranial pressure are resolved | *A baseline neuropsychological examination when symptoms of endocrine deficiency and raised [[intracranial pressure]] are resolved | ||
===HEENT=== | ===HEENT=== | ||
*Paralysis of upward gaze | *Paralysis of upward gaze | ||
*Pupils nonreactive to light perception and accommodation or pupils which react better to accommodation than light | *Pupils nonreactive to light perception and accommodation or [[pupils]] which react better to accommodation than light | ||
*Nystagmus | *[[Nystagmus]] | ||
*Failure of convergence | *Failure of convergence | ||
*Lid retraction | *Lid retraction | ||
*Visual-field examinations | *Visual-field examinations | ||
*Papilledema | *[[Papilledema]] | ||
*A baseline neuropsychological examination is also performed | *A baseline neuropsychological examination is also performed | ||
===Neuromuscular=== | ===Neuromuscular=== | ||
*Patient is usually oriented to persons, place, and time: However, altered mental status may be present if there is increased intracranial pressure | *Patient is usually oriented to persons, place, and time: However, altered mental status may be present if there is increased intracranial pressure | ||
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*Positive Babinski / plantar reflex unilaterally/bilaterally | *Positive Babinski / plantar reflex unilaterally/bilaterally | ||
*Proximal/distal muscle weakness unilaterally/bilaterally | *Proximal/distal muscle weakness unilaterally/bilaterally | ||
*Paralysis of upward gaze, failure of convergence, and pupils nonreactive to light perception and accommodation suggestive of cranial nerve II and III | *Paralysis of upward gaze, failure of convergence, and pupils nonreactive to light perception and accommodation suggestive of [[cranial nerve]] II and III deficit | ||
*Unilateral/bilateral upper/lower extremity weakness | *Unilateral/bilateral upper/lower extremity weakness | ||
*Unilateral/bilateral sensory loss in the upper/lower extremity | *Unilateral/bilateral sensory loss in the upper/lower extremity | ||
*Ataxia | *[[Ataxia]] | ||
*Normal finger-to-nose test / Dysmetria | *Normal finger-to-nose test / [[Dysmetria]] | ||
*Dysdiadochokinesia | *[[Dysdiadochokinesia]] | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
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[[Category:Rare diseases]] | [[Category:Rare diseases]] | ||
[[Category:Pediatrics]] | [[Category:Pediatrics]] | ||
[[Category:Gynecology]] | [[Category:Gynecology]] | ||
[[Category:Proctology]] | [[Category:Proctology]] | ||
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{{WikiDoc Help Menu}} | {{WikiDoc Help Menu}} | ||
{{WikiDoc Sources}} | {{WikiDoc Sources}} | ||
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[[Category:Neurology]] | |||
[[Category:Neurosurgery]] | |||
Latest revision as of 23:35, 26 November 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]
Overview
Common physical examination findings of germinoma include paralysis of upward gaze, pupils nonreactive to light perception and accommodation or pupils which react better to accommodation than light, nystagmus, failure of convergence, lid retraction, papilledema, ataxia, and neurologic examination may be abnormal depending on the location of the tumor.
Physical Examination
The clinical evaluation for germ cell tumors should include the following:[1]
- General physical examination
- Check of growth parameters
- Careful neurological evaluation
- Assessment of primary and secondary sexual characteristics
- Ophthalmological exam
Radiographic characteristics of CNS germ cell tumors GCTs cannot reliably differentiate germinomas from nongerminomatous germ cell tumors NGGCTs. The diagnosis of GCTs is based on the following:
- Clinical signs and symptoms
- Tumor markers (Alpha-fetoprotein (AFP) and beta subunit human chorionic gonadotropin (beta-HCG) in both serum and CSF, lumbar CSF cytology)
- Neuroimaging
- Cytological cerebrospinal fluid (CSF) and histological confirmation
- Magnetic resonance imaging (MRI) of brain and spine with gadolinium
- Evaluation of pituitary/hypothalamic function
- Visual-field examinations for suprasellar or hypothalamic tumors
- A baseline neuropsychological examination when symptoms of endocrine deficiency and raised intracranial pressure are resolved
HEENT
- Paralysis of upward gaze
- Pupils nonreactive to light perception and accommodation or pupils which react better to accommodation than light
- Nystagmus
- Failure of convergence
- Lid retraction
- Visual-field examinations
- Papilledema
- A baseline neuropsychological examination is also performed
Neuromuscular
- Patient is usually oriented to persons, place, and time: However, altered mental status may be present if there is increased intracranial pressure
- Clonus may be present
- Hyperreflexia / hyporeflexia / areflexia
- Positive Babinski / plantar reflex unilaterally/bilaterally
- Proximal/distal muscle weakness unilaterally/bilaterally
- Paralysis of upward gaze, failure of convergence, and pupils nonreactive to light perception and accommodation suggestive of cranial nerve II and III deficit
- Unilateral/bilateral upper/lower extremity weakness
- Unilateral/bilateral sensory loss in the upper/lower extremity
- Ataxia
- Normal finger-to-nose test / Dysmetria
- Dysdiadochokinesia
References
- ↑ Germ cell tumors. National Cancer Institute(2015) http://www.cancer.gov/types/brain/hp/child-cns-germ-cell-treatment-pdq#link/_60_toc Accessed on February 16, 2016