Question of the Week # 240

240) A 55 year old woman is evaluated in the emergency room for acute development of double vision and droopy right eyelid. She also reports pain in her right eye. She denies any fever.  She has no significant past medical history. On physical examination, she is afebrile and her blood pressure 132/88 mm Hg. Head and neck examination reveals ptosis of the right eyelid. Pupillary light reflex is lost. She can not adduct her right eye past the midline. The right 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.

The  most appropriate next step in management?

A)     Temporal artery biopsy

B)     Obtain Erythrocyte Sedimentation Rate

C)     Observation

D)     Magenetic Resonance Angiography (MRA)

E)     Ptosis Surgery

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

Question of the Week # 238

238) 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 cause of her symptoms?

A)     Ophthalmoplegic migraine

B)     Diabetic Mono-neuropathy

C)     Posterior communicating artery aneurysm

D)     Weber syndrome

E)     Lateral medullary syndrome

Question of the Week # 209

209)  A 35 Year old woman presents for evaluation of recurrent headaches for the past few months.  Lately, she has been waking up with a headache almost daily though it tends to improve in the latter half of the day. She is frustrated as she can not even get some sleep during the attack since lying down makes her feel worse . She has associated nausea. She has transient attacks of light flashes  that resolve spontaneously. Her menstrual history is unremarkable. On physical examination, she has no neurological deficits. Funduscopic examination shown below:

Which of the following information, if elicited in the patient history, would increase the clinical suspicion of the diagnosis?

A)     Constipation

B)      Family History

C)      Recent weight gain

D)      Galactorrhea

E)      Urinary incontinence

%d bloggers like this: