Neuro-oph Case 3: Physical Exam

Neuro-oph Case 3 Index

Physical Exam: 

Vitals: Temp: 37.0C, BP: 110/72, HR 70, RR 16, BMI: 24 kg/m2
VA with correction: OD 20/20, OS 20/50
Pupils: equal and reactive OU, 3+rAPD OS
Intraocular pressures (IOP) by tonopen in ED: 16 mmHg OU
EOM: full OU, no nystagmus
Confrontation Visual Fields (CVF): OD visual fields intact to finger count, OS restricted superiorly
Red desaturation test: OD 100%, OS 60% 

External ocular exam:
Eyelids: flat OU, no ptosis OU
Conjunctiva: white and quiet OU
Cornea: Clear OU
Anterior Chamber: Formed OU
Iris: flat OU
Lens: clear OU

Neuro Exam: Mental status exam is unremarkable. Cranial nerves are intact other than the left APD and decreased acuity. Motor, coordination, and gait exams are normal. There is mildly decreased sensation to pinprick in the right leg and foot. Reflexes are 2+ throughout except at the right patella which is 3+. Babinski sign is present on the right.

Fundoscopic exam of the right eye is within normal limits. Fundoscopic exam of the left eye shows the following:

left optic neuritis AAO

Above Image Credit: © 2020 American Academy of Ophthalmology

How would you describe the left fundus appearance?
Scattered hemorrhages throughout the macula
Diffuse retinal whitening with cherry red spot centrally
Optic disc swelling
Optic nerve cupping

What tests do you want to order next?
MRI brain and orbits
CT head and orbits
Lumbar puncture
Electroencelphalogram (EEG)

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Neuro-oph Case 3 Index

Neuro-oph Case 3: Introduction