Neuro-oph Case 4: Introduction

History of Present Illness (HPI)

A 46 year old female with a past medical history of hypertension and type 2 diabetes mellitus presents to the emergency department due to sudden onset of double vision. She states she was reading emails on her computer this morning when suddenly she began seeing double. Over the past few hours, her double vision has persisted, and she notices that it worsens when she looks towards the left. When she covers each eye individually her double vision resolves, but her vision in the right eye seems blurry. She denies fatigue, headache, nausea, vomiting, changes in sensation, or weakness. She denies flashes and floaters. She drinks 1-2 alcoholic beverages per week, denies cigarette smoking and drug use. She denies recent illness, sick contacts, or recent travel. Her daughter told her that her right eye looks “droopy” and subsequently brought her to the hospital.

She reports following up with her physicians regularly and compliance with all of her medications. Her HbA1c was 6.7% last month.


Family history: Her family history is significant for her father who died suddenly at age 54 from bleeding in the brain.

What’s on your differential diagnosis? Choose at least 3 before moving on!
Myasthenia Gravis
Bell’s palsy
Horner’s syndrome
CNIII (Oculomotor nerve) palsy
CNVI (Abducens nerve) palsy
Temporal arteritis
CNIV (Trochlear nerve) palsy
Internuclear ophthalmoplegia
Cavernous sinus thrombosis

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