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
