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Q: What up doc. This patient’s eyes don’t move right - tell me how to assess and tell me short and sweet.
A: If patient can’t move eyes to command but can reflex when you snap your fingers right and left - that’s supranuclear - think PSP.
A: If pupils are affected, that’s pre-synaptic or compressive CN3. Think Botox or aneurysm or tumor.
A: If eyes don’t move right and he’s got double vision on and off, think myasthenia gravis.
A: If eyes don’t move right and he’s not got double vision, think slowly progressing mitochondrial myopathy or oculopharyngeal muscular dystrophy.
Bonus point: Ptosis doesn’t always go with opthalmoplegia and opthalmoplegia doesn’t always mean double vision - no opthalmoplegia in myotonic dystrophy even though they can look much like the mitochondrial myopathies
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