Neuro-oph Case 2: Case Continued…

Neuro-oph Case 2 Index

Answer: You astutely note optic disc swelling (edema), which you suspect to be papilledema in both eyes. You also note the appearance of macular (retinal) folds adjacent to the nerve caused by the edema.

You order an MRI brain and MRV, and consult neurology and ophthalmology.

When the neurology resident arrives, the patient is being wheeled back from radiology.

You pull up the MRI and MRV images and see this:

The radiology report reads:
“MRI Brain: No evidence of ischemia, hemorrhage, inflammation, or mass lesion. 

MRV Head: Patent dural venous sinus system.”   

The neurology team performs a lumbar puncture which reveals an opening pressure of 27 cm H20. CSF analysis shows the following: RBC 0, WBC 2, glucose 63, protein 32. 

What other cranial nerve (CN) abnormality can be associated with the most likely diagnosis?
CNVII (Facial nerve) palsy
CNIV (Trochlear nerve) palsy
CNIII (Oculomotor nerve) palsy
CNVI (Abducens nerve) palsy
CNV (Trigeminal nerve) palsy
No other cranial nerve palsies are associated with the most likely diagnosis

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Neuro-oph Case 2 Index

Neuro-oph Case 2: Introduction
Neuro-oph Case 2: Additional History and Physical Exam