tailieunhanh - Case Files Neurology - part 7

Một người đàn ông 65 tuổi có tiền sử tăng huyết áp, bệnh động mạch vành và bệnh Alzheimer sớm trình bày với một khiếu nại của tầm nhìn tăng gấp đôi kể từ ngày hôm qua. Ông đã không có kinh nghiệm đau ngực, đánh trống ngực ngực, buồn nôn, chóng mặt, chóng mặt, nhức đầu, điểm yếu trên khuôn mặt | CASE 34 A 65-year-old man with a history of hypertension coronary artery disease and early Alzheimer disease presents with a complaint of double vision since yesterday. He has not experienced chest pain chest palpitations nausea lightheadedness vertigo headache facial weakness hemisensory loss hemiparesis loss of balance hearing loss tinnitus visual loss ptosis or proptosis. He has noticed that covering up either eye corrects his double vision. He has resorted to wearing an eye patch since yesterday so that he can see and walk without falling. In fact he was able to drive on his own on the freeway to your office much to his family s dismay. On further questioning you elicit the history that his double vision occurs only on horizontal gaze and not vertical gaze. He has been compliant with his medications for hypertension and coronary artery disease. On examination his blood pressure BP is 124 72 mmHg with a heart rate HR of 88 beats min. He is afebrile and has a regular rate and rhythm without murmurs on cardiac examination. There are no carotid bruits and his peripheral pulses are normal. His neurologic examination is notable for intact orientation and intact motor strength. His cranial nerve examination is remarkable only for a right lateral rectus palsy. Sensory examination is normal and his deep tendon reflexes are 2 throughout. Plantar responses are flexor. His gait is normal. Review of his daily blood pressure log shows stable pressures of 130 70 mmHg. What is the most likely diagnosis What is the neurologic deficit 284 CASE FILES NEUROLOGY ANSWERS TO CASE 34 Sixth Nerve Palsy Ischemic Mononeuropathy Summary A 65-year-old man with hypertension coronary artery disease and early Alzheimer disease presents with a 24-hour history of binocular horizontal diplopia double vision . He has not experienced associated symptoms such as chest pain or headache. His examination is significant for a normal blood pressure and heart rate and the findings of the isolated right