how to print barcode in asp.net c# Figure 31-20 T1-weighted sagittal MRI demonstrating a meningioma just below the foramen magnum in Microsoft Office

Create Quick Response Code in Microsoft Office Figure 31-20 T1-weighted sagittal MRI demonstrating a meningioma just below the foramen magnum

Figure 31-20 T1-weighted sagittal MRI demonstrating a meningioma just below the foramen magnum
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occipital neuralgia with a foramen magnum syndrome is particularly suggestive of a tumor at that site Treatment is surgical excision (see Hakuba et al) followed by focused radiation if the resection has been incomplete and the tumor is known to be radiosensitive
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REMOTE EFFECTS OF NEOPLASIA ON THE NERVOUS SYSTEM (PARANEOPLASTIC DISORDERS) (Table 31-5)
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In the past 50 years there has been delineated a group of neurologic disorders that occur in patients with carcinoma or some other type of neoplasia even though the nervous system is not the site of metastases or direct invasion or compression by the tumor These so-called paraneoplastic disorders are not speci c or con ned to cancer, but the two conditions are linked far more frequently than could be accounted for by chance They assume special importance because the neurologic syndrome in many cases becomes apparent before the underlying tumor is found Some of the paraneoplastic disorders that involve nerve and muscle namely, polyneuropathy, polymyositis, and the myasthenic-myopathic syndrome of Lambert-Eaton are described on pages 1194 and 1259, respectively Here we present several other paraneoplastic processes that involve the spinal cord, cerebellum, brainstem, and cerebral hemispheres Comprehensive accounts of the paraneoplastic disorders may be found in the writings of Posner, Darnell and Posner, and of Dropcho Some of these disorders are associated with IgG autoantibodies (Table 31-5), but it should be remarked that although certain antibodies are associated with speci c syndromes, they are not invariably linked to particular cancers Furthermore, the
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INTRACRANIAL NEOPLASMS AND PARANEOPLASTIC DISORDERS
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Table 31-5 The main paraneoplastic disorders and their associated autoantibodiesa
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PREDOMINANT NEUROLOGIC DISORDER CLINICAL FEATURES AUTOANTIBODY TUMOR
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Cerebellar degeneration Encephalomyelitis
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Ataxia, subacute Subacute confusion, brainstem signs, myelitis
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Opsoclonus-myoclonus-ataxia Ocular movement disorder, gait ataxia Retinal degeneration Scotomas, blindness, disc swelling Antirecoverin (Anti-CAR) Subacute sensory neuropathy and neuronopathy Lambert-Eaton myasthenic syndrome Stiff-man syndrome Chorea Optic neuropathy
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Anti-Yo (anti-Purkinje cell) Ovary, fallopian tube, lung, Hodgkin disease (anti-Tr) Anti-Hu (ANNA 1) Small-cell lung, neuroblastoma, Anti-Ma prostate, breast, Hodgkin, testicular (Ma) Anti-Ri (ANNA 2) Breast, fallopian tube, small-cell lung
Distal or proximal sensory loss Proximal fatiguing weakness, autonomic symptoms (dry mouth) Muscle spasms and rigidity Bilateral choreoathetosis Blindness
Small-cell lung, thymoma, renal cell, melanoma Anti-Hu (ANNA-1) Small-cell lung, Hodgkin, other lymphomas Anti-voltage-gated (VGCG) Small-cell lung, Hodgkin, other calcium channel lymphomas Breast Lung, Hodgkin, others Lung
Antiamphiphysin Anti-Hu, CRMP-5 Anti-CRMP-5
In most cases, a particular autoantibody is associated with a speci c tumor type rather than with the clinical syndrome (eg, small-cell lung cancer and polyneuropathy with ANNA 1, breast cancer with anti-Purkinje cell antibody, testicular tumors with anti-Ma) Clinical syndromes similar to each of these may occur with non small cell lung cancer and lymphoma, most often in the absence of detectable antibodies
same syndromes and antibodies occur rarely without an evident tumor Small-cell cancer of the lung, adenocarcinoma of the breast and ovary, and Hodgkin disease are the tumors most often associated with these disorders, but the paraneoplastic neurologic syndromes occur in only a very small proportion of these cases The mechanism(s) by which carcinomas produce their remote effects are poorly understood Perhaps the most plausible theory, as intimated above, is that they have an autoimmune basis According to this theory, antigenic molecules are shared by certain tumors and central or peripheral neurons The immune response is then directed to the shared antigen in both the tumor and the nervous system The evidence for such an autoimmune mechanism is most clearly exempli ed by the Lambert-Eaton syndrome, in which an antibody derived from a tumor binds to voltage-gated calcium channels at neuromuscular junctions (Chap 53) Furthermore, in some types of paraneoplastic disorders, there is provocative evidence that the inciting tumor has receptors for the antibody on its surface and the self-binding of the antibody may inhibit tumor growth This is said to account for the dif culty in detecting diminutive small-cell lung cancers that underlie some of the paraneoplastic syndromes It should be noted, however, that there is no evidence that suppressing or removing the antibody leads to growth of the tumor
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