Neuro-oph Case 4: Physical Exam

Neuro-oph Case 4 Index

Physical Exam: 

Vitals: Temp: 36.8C, BP: 132/82, HR 64, RR 16, glucose fingerstick is 90 mg/dl

On external exam you see the following:

external complete R ptosis AAO
Above Image Credit: © 2020 American Academy of Ophthalmology

VA with correction: OD 20/50 (upon lifting of the right eyelid), OS 20/20
Pupils: OD mid-dilated pupil and nonreactive to light, OS round and reactive to light
Intraocular pressures (IOP) by tonopen in ED: 14 mmHg OU
Confrontation Visual Fields (CVF): visual fields intact to finger count OU
EOM: see image below:

CNIII montage AAO
Above Image Credit: © 2020 American Academy of Ophthalmology

External ocular exam continued:
Eyelids: complete ptosis of the Right upper eyelid, left eyelid appears within normal limits
Conjunctiva: white and quiet OU
Cornea: Clear OU
Anterior Chamber: Formed OU
Iris: flat OU
Lens: 1+NS cataracts OU
(see case 1 for more information on cataracts)

Remaining Neuro Exam: The remainder of the cranial nerves and neurologic examination are all normal.

Fundoscopic exam of both eyes is within normal limits. 

What is the acuity of the presentation?
Emergency! Obtain stat neuroimaging, and consult ophthalmology and neurology  
Non urgent, can see ophthalmology and neurology in a week for follow up motility exam

Click here to move on!

Neuro-oph Case 4 Index

Neuro-oph Case 4: Introduction