CASE 8

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History

A 42-year-old woman had been in good health until today, when she suddenly developed diplopia in all fields of gaze. The accompanying photograph was taken while the patient was asked to look up.

Questions

1. Describe the ocular findings in the photograph.

 

2. Provide a pathophysiologic explanation for these findings.

 

3. What would the examination of the pupillary reflexes be likely to show?

 

4. Outline a differential diagnosis for the etiology.

 

5. What questions would you ask the patient when reviewing her general health?

 

6. What would be your plan for workup?

 

7. How would the findings in question #3 alter your plan for management?