Question of the Week # 239

239) A 64 year old woman is evaluated in the emergency room for acute development of double vision and droopy left eyelid. She denies any fever or headache.  Her past medical history is significant for diabetes mellitus and hypertension. On physical examination, she is afebrile and her blood pressure 132/88 mm Hg. Head and neck examination reveals ptosis of the left eyelid. Pupillary light reflex is intact . She can not adduct her left eye past the midline. The left eye is deviated downwards and laterally as shown in the picture below. There is no sensory loss on her face and the function of her other facial muscles are intact. Power is normal in all her extremities and deep tendon reflexes are intact.

Which of the following is the most likely eventual outcome of her condition?

A)     Sub-arachnoid hemorrhage

B)     Spontaneous resolution

C)     Cerebellar ataxia

D)     Persistent visual deficits

E)     Aneurysmal Rupture

7 Responses

  1. b

  2. b

  3. e

  4. Cranial mononeuropathy most often involves cranial nerves (CN) III, IV, VI, VII, or II. Disease of CN III, IV, and VI manifests as acute or subacute periorbital pain or headache followed by diplopia. Muscle weakness is typically in the distribution of a single nerve, and pupillary light reflexes are usually spared. Complete spontaneous recovery usually occurs within 3 months.
    emedicine.com

  5. multiple sclerosis patient ??

  6. B

  7. due to dm?

    wil there b resolution of complaint

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