The correct diagnosis of the module below will be the topic of our February 5th and February 19th  Podcasts.

Treat the Sneak Peek

A 24-year-old female presents with blurry vision and difficulty walking.


HISTORY: 

HPI: A 24-year-old woman comes into your office complaining of new onset diplopia when looking to the right and difficulty walking. She tells you that one year ago, she had an episode of blurred vision in her left eye that lasted for three weeks. The symptoms returned over the past week. This time they are accompanied by difficulty walking due to left leg weakness. 


PMH: No previous history of hospitalizations or surgeries.

Medications: None

Family Hx: Mother has hypothyroidism. Father has HTN.

Social Hx: Does not smoke, drink, or use illicit substances.

​Allergies: NKDA


ROS: Negative except noted above.


EXAMINATION:


Temperature: 37°C (98.6°F)
HR: 67 bpm
RR: 14/min

SpO2: 98% on room air


Neuro: 20/50 OS, 20/20 OD Her direct and consensual pupillary responses are normal when a light is flashed into her right eye; however, both pupils dilate when the light is moved quickly to the left eye. Extraocular muscle testing shows decreased adduction of the left eye on right gaze, which is associated with horizontal nystagmus in the right eye. The left eye abducts normally, and the right eye adducts normally, on left gaze.  Quadriceps strength is 3/5 on the right, 5/5 on the left. Patellar reflexes are 4+ on the right, 2+ on the left.


CV: Regular rate and rhythm, S1 and S2 intact, no murmurs, rubs, or gallops


Lungs: clear to auscultation bilaterally.