Neurology: Case of the Month

Test Yourself — Patient 47

Polyclonal Plasma Cell Hyperplasia Involving the Meninges ("Inflammatory Pseudotumor")

1. A marked clinical response to glucocorticoids may be associated with which of the following:
   • [ A ] Lymphoma
   • [ B ] Sarcoidosis
   • [ C ] Multiple sclerosis
   • [ D ] B and C
   • [ E ] All of the above
2. Which of the following statements is TRUE?
   • [ A ] Granulomas with caseating necrosis are typical of CNS sarcoidosis.
   • [ B ] Chronic aseptic meningitis is rarely associated with treatable disorders.
   • [ C ] An elevated antinuclear antibody level in association with aseptic meningitis is diagnostic of systemic lupus erythematosus.
   • [ D ] Meningeal inflammation may be associated with evidence of inflammation in other organ systems.
3. Brain and/or meningeal biopsy is mandatory in all cases of aseptic meningitis which cannot be diagnosed by less invasive testing.
   • [ A ] True
   • [ B ] False
4. Plasma cell proliferation in the CNS is LEAST likely to result from WHICH of the following:
   • [ A ] Hamartoma
   • [ B ] Syphilis
   • [ C ] Multiple myeloma
   • [ D ] Wegener's granulomatosis
5. Which of the following is LEAST consistent with a diagnosis of idiopathic intracranial hypotension (Schaltenbrand's syndrome)?
   • [ A ] Normal CSF pressure during an initial lumbar puncture
   • [ B ] Optic disc blurring
   • [ C ] Subdural hematoma
   • [ D ] Mild CSF pleocytosis
   • [ E ] Elevated serum or CSF angiotensin-converting enzyme (ACE) level

 

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