Saturday, 24 March 2012

Case study: horizontal diplopia

A 32-year woman presents with horizontal double vision on looking to the left. It is noted that her right eye fails to adduct and that there is nystagmus in the left eye. The remainder of her neurological examination is normal except for bilaterally upgoing plantar responses, i.e. bilaterally positive Babinski responses.

Level 1
What is the differential diagnosis?
Describe the neuroanatomy of horizontal eye movements?
Why does she not have a 3rd nerve palsy?
What is the significance of the the upgoing plantar responses?

Level 2
What investigations would you do?

Level 3
Why does she have nystagmus in the abducting left eye?
What happens to convergence?

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