Uploaded by Dr. Erica Rivera

CLK Rivera,Erica E Batch 2 Neuro ophtha Cases

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CLERK Rivera, Erica E.
August 16-30 Rotators
Neuro ophthalmology Cases
Fundoscopic findings: Pale optic disk with not well-delineated margins
Perimetry Findings: Bitemporal Hemianopsia
Impression : PITUITARY ADENOMA
Basis:
• Female
• Age
• Blurring of vision for 1 month
• Irregular menstruation
• Pale optic Disc
• Bitemporal hemianopsia
CRANIOPHARYNGIOMA
RULE IN
• Bitemporal
hemianopsia
• Blurring of vision
• Irregular menstruation
RULE OUT
• Headache
• Weight gain
• Fatigue
• Cold intolerance
Meningioma
•
•
•
•
•
Blurring of vision
Irregular menstruation
Bitemporal
hemianopsia
•
•
•
•
•
Headache
Anosmia
Diplopia
Facial Paresis
Seizure
Plan and Management
Request for MRI with contrast to evaluate and confirm the presence of Pituitary Adenoma
Refer to Endocrinologist for proper management
Case 2
50/M came for consult due to diplopia since yesterday, persistence prompted consult
PMHX: (+) HPN for 10 years, (+) DM for 5 years; non-compliant to medications
Clinical impression: Third Nerve Palsy Secondary to uncontrolled Hypertension and Diabetes Mellitus
Basis:
• Diplopia
• Ptosis
• Anisocoria
• Limited ocular movement ( weakness in depression and adduction )
• History of DM an hypertension
Differential Diagnosis
RULE IN
RULE OUT
Myesthenia Gravis
• Diplopia
• Strabismus
• Ptosis
• Muscle weakness
Horner’s Syndrome
• Anisocoria
• Miosis
• Ptosis
• Hyperchromic
heterochromia
• Anhidrosis
Plan and Management
• CT angiography to evaluate and rule out other disease entities.
• Uniocular occlusion for partial ptosis
• Neurosurgery consult
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