Neuro-oph Case 5: Physical Exam

Neuro-oph Case 5 Index

Physical Exam: 

General: Well nourished, well groomed, age-appearing male fidgeting in chair
Mental status exam: Oriented to self, place, day of week, year. Does not know the date.
Able to spell WORLD forwards, unsuccessful backwards.
Naming intact to high and low frequency objects.
Follows simple and multi-step commands across the midline.
Repetition intact. Recalls 3/3 items (apple, friendship, bus) immediately and 2/3 after ~5 minutes.
Aware of current events, has some trouble recalling remote events.
Remaining Neuro exam: The patient has no motor, sensory, or coordination deficits and reflexes are symmetric throughout.

Vitals: Temp: 36.2C, BP: 118/75, HR 60, RR 15 
VA with correction: OD 20/30, OS 20/30
Pupils: equal and reactive OU, no rAPD
EOM: full OU, no nystagmus
Confrontation Visual Fields (CVF): OD restricted supererotemporally, OS restricted superonasally

External ocular exam: within normal limits OU 

Fundoscopic exam of  both eyes reveal pink optic nerves with sharp margins. There is no edema or pallor OU.

You find the visual field test performed last week at the ophthalmologist’s office, which shows the following:




How would you describe the visual field defects seen?
Bitemporal hemianopia
Homonymous hemianopia
Superior arcuate defect
Homonymous superior quandrantanopia
Junctional scotoma

What tests do you want to order next?
Montreal Cognitive Assessment (MOCA)
Vitamin B12 levels
MRI brain with contrast

Click here to move on!

Neuro-oph Case 5 Index
Neuro-oph Case 5: Introduction