![]() ![]() APPLICATION CENTRIC COMPUTING LTD GDPR STATEMENT.Differential diagnosis and management of acquired sixth cranial nerve palsy. A second follow up 12 weeks later should be scheduled to confirm resolution of the diplopia.”ġ. Goodwin D. “The patient can return to your office six weeks from the onset of initial symptoms. ![]() She says to inform your patient that if symptoms worsen, new symptoms begin, or if symptoms do not resolve within 12 weeks, head and orbital imaging will be needed. His palsy resolved within nine weeks of the intital visit. The request was ignored and the patient sent for an MRI, which came back negative. “This particular patient was sent back to his internist with my recommendation to evaluate for diabetes and to assess the adequacy of the type and dosage of his hypertension medication,” Dr. Williams advises telling patients it is essential to follow up with their PCP or internist to monitor uncontrolled systemic disease such as diabetes and hypertension as was seen in her patient. If the patient has diabetes, it is worth mentioning that reoccurrence of the palsy is certainly possible.”ĭr. “Educate the patient on the potential etiologies underlying their symptoms. In the absence of abnormal blood pressure, these patients do not need to be sent to the ER. This patient presented to the office with an abduction deficit in the right eye on right gaze. Williams also advises performing a dilated fundus examination to rule out specific vascular etiologies such as retinopathy from hypertension or diabetes. “Cover test will reveal a greater esotropia at distance than near and EOM testing will show the inability of the ipsilateral eye to abduct and will be accompanied by diplopia in that field of gaze.”ĭr. “Visual acuity, IOP, visual field results, pupils and slit lamp measurements should not be affected from an isolated CN-VI palsy,” says Dr. The key findings for determining CN-VI etiology typically manifest as the exam progresses. ![]() “And, always bear in mind the remote possibility of an etiology consisting in a benign or malignant growth.” Williams says that when communicating with a CN-VI patient, observe for neurological symptoms indicative of prior vascular incidents like stroke. When a patient over age 50 presents with sudden-onset horizontal and binocular double vision, immediately think CN-VI palsy secondary to a vascular etiology.
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