#NeurologyMorningReport Case 31 #MedTwitter Updates & Answers posted later today. Asking your help #MedEd #neurology #neurologyresident #futureneurologist #medstudent Join me in educating. Share your questions and knowledge.
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65 yo M p/w intermittent horizontal double vision. Went to an ophthalmologist who diagnosed decompensated phoria. Comes for a 2nd opinion. Healthy -no PMH. No meds. SH: No T/E/D. FH: nothing pertinent. What other pertinent questions do you have? How will you focus your exam?
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Great Qs from everyone- such great learning-teaching through seeing what everyone wants to know& examine!
Occurs at night & when tired; goes away when he closes either eye (i.e.has binocular diplopia). Also has drooping of his eyelids at night. Improves after closing eyes
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Occurs at night & when tired; goes away when he closes either eye (i.e.has binocular diplopia). Also has drooping of his eyelids at night. Improves after closing eyes
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No proximal m weakness (going up stairs or brushing hair). No slurred speech or trouble swallowing. No nausea, vomiting or headache. No nystagmus. Pertinent exam is shown in prior video. No weakness in extremities. Teaching point demonstrated in this video simulation.
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Re cover, uncover, alternating cover testing - Dr. Andrew Lee has a great youtube channel & discusses here youtube.com/watch?v=_NcjHC…
I also love the creativity of the eye movements on this video from Minaa Ashfaq youtube.com/watch?v=dsH7eK…
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I also love the creativity of the eye movements on this video from Minaa Ashfaq youtube.com/watch?v=dsH7eK…
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More teaching always appreciated.
Which of the following tests would YOU perform next? Comments re sensitivity/specificity appreciated.
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Which of the following tests would YOU perform next? Comments re sensitivity/specificity appreciated.
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A great bedside exam pearl from our award winning #neurology educator, #neurologyresident PD, and Chief of #NeuroOphthalmology Dr. Sashank Prasad who also wrote this for our website
brighamandwomens.org/neurology/neur…
brighamandwomens.org/neurology/neur…
Dx: #OcularMyastheniaGravis
Another great case from Dr. Wray and her fabulous teaching collection collections.lib.utah.edu/details?id=188…
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Another great case from Dr. Wray and her fabulous teaching collection collections.lib.utah.edu/details?id=188…
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Cogan's Twitch - Described by David Cogan in 1965- you can see it best in the most ptotic eye. The patient looks down and then when looking upward there is a quick,tiny, subtle improvement of ptosis that looks like a twitch. @neurosigns-org youtube.com/watch?v=1GrHIv…
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Sensitivity of antibodies in ocular myasthenia. Note that as
@ElieNaddaf3 pointed out edrophonium is obsolete (Tensilon is not longer available in US)
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@ElieNaddaf3 pointed out edrophonium is obsolete (Tensilon is not longer available in US)
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Some advice from an expert - Dr. Tony Amato - including treatment regimen
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We moved fast to dx, but the real pt was not dx'd quickly. "The disease is usually easy to diagnose if it is suspected; yet it is one of the most missed diagnoses, because of common failure to consider it in a differential diagnosis" -Dr. Cogan,1965. Still so true today
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This is a short video clip on the neuromuscular junction from our The Neurology Video Primer with @tammyb84 @OUPAcademic
oxfordmedicine.com/view/10.1093/m…
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oxfordmedicine.com/view/10.1093/m…
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Another clip from The #Neurology Video Primer on MG and LEMS; many medical schools have this available for free for their #medicalstudents
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