Given these changes from the original case, what is your diagnosis?
What is your diagnostic explanation?
As compared to the long case, this patient is a 5 year old boy who has lost his balance many times over the last 3 weeks. Each time, he simply appears to lose his balance and fall down. He’s had a few cuts/bruises but has never been down for long. He always gets up right away and shakes it off. He has never had any twitches during a fall or loss of muscle tone after a fall. He has also complained of headaches in the morning for the last two weeks. His mother took him to Prompt Care after his balance worsened over the last two days.
PMH: History of bilateral tympanostomy, myringotomy and tube placement. No other surgeries or hospitalizations.
Physical Exam: Patient is active and plays happily in the room. His gait is wide-based, and if he doesn’t lean against a chair or table he has trouble maintaining his balance. Eye exam shows rapid jerking/dancing movements (opsomyoclonus). Heel-to-shin test revealed in-coordination bilaterally, worse on the right. Finger-to-nose test was not completed due to inattention.
CT scan with contrast shows a ring enhancing lesion in the right hemisphere of the cerebellum with no mid-line shift or signs of herniation.