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1. Johns Hopkins University School of MedicineClinico-Pathological Conference Benjamin M. Greenberg, M.D., M.H.S.
Assistant Professor
Department of Neurology
Johns Hopkins School of Medicine
3. Differential Diagnosis at This Point
4. Differential Diagnosis at This Point
5. Differential Diagnosis at This Point
6. Differential Diagnosis at This Point
7. Differential Diagnosis at This Point
8. Differential Diagnosis at This Point
9. Differential Diagnosis at This Point
10. Differential Diagnosis at This Point
11. Differential Diagnosis at This Point
12. Differential Diagnosis at This Point
13. Differential Diagnosis at This Point
24. Subacute Central Nervous System Degeneration with Parkinsonism, Eye Movement Abnormalities and Frontal Love Dysfunction “Degenerative”
Parkinson’s Disease
Progressive Supranuclear Palsy
Corticobasal Degeneration
Diffuse lewy body disease
Toxic/Metabolic
Wilson’s
Manganeese
MPTP
Infectious
Whipple’s
Prion Diseases
Flaviviruses
Mitochondrial Disorders Nutritional
Deficiencies
B12
Thiamine
Medications/Drugs
Dopamine Antagonists
Immune Mediatied
Paraneoplastic
ADEM
Multiple Sclerosis
Neoplastic
CNS lymphoma
Intravascular lymphoma
Glioma
29. Subacute Central Nervous System Degeneration with Parkinsonism, Eye Movement Abnormalities and Frontal Love Dysfunction “Degenerative”
Parkinson’s Disease
Progressive Supranuclear Palsy
Corticobasal Degeneration
Diffuse lewy body disease
Toxic/Metabolic
Wilson’s
Manganeese
MPTP
Infectious
Whipple’s
Prion Diseases
Flaviviruses
Mitochondrial Disorders Nutritional
Deficiencies
B12
Thiamine
Medications/Drugs
Dopamine Antagonists
Immune Mediatied
Paraneoplastic
ADEM
Multiple Sclerosis
Neoplastic
CNS lymphoma
Intravascular lymphoma
Glioma
30. Whipple’s Disease First described in 1907 by George Hoyt Whipple, a JHH pathologist
He developed recurring arthropathy, weight loss, and steatorrhoea, became worse, and died. At necropsy the intestine and mesenteric lymph glands were infiltrated by mononuclear cells and deposits of fat.
Weakly gram positive rod, Actinomycetes
Neurologically
Cognitive decline
Vertical Gaze difficulty
Oculomasticatory myorhythmia
Movement disorders
31. Paraneoplastic Subacute presentations
Opsoclonus
small cell lung cancer
Neuroblastoma
Gynecologic malignancies
Limbic Encephalitis
small cell lung cancer (anti-Hu)
Germ cell tumors
can have brainstem encephalitis.
Can precede malignancy by years
33. Paraneoplastic Syndrome (Whipple’s is a close second)