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  #1  
Old 03-05-2013
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Default PCA aneurysm?

A 55 year old woman is evaluated in the emergency room for acute development of double vision and droopy right eyelid. She also reports pain in her right eye. She denies any fever. She has no significant past medical history. On physical examination, she is afebrile and her blood pressure 132/88 mm Hg. Head and neck examination reveals ptosis of the right eyelid. Pupillary light reflex is lost. She can not adduct her right eye past the midline. The right eye is deviated downwards and laterally as shown in the picture below. There is no sensory loss on her face and the function of her other facial muscles are intact. Power is normal in all her extremities and deep tendon reflexes are intact.

http://usmlegalaxy.files.wordpress.c...1/07/face1.jpg

The most appropriate next step in management?

A) Temporal artery biopsy

B) Obtain Erythrocyte Sedimentation Rate

C) Observation

D) Magenetic Resonance Angiography (MRA)

E) Ptosis Surgery
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radkur (03-09-2013)



  #2  
Old 03-05-2013
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D) Magenetic Resonance Angiography (MRA)
__________________
A man doesn't know what he knows until he knows what he doesn't know.
“What is man? He's just a collection of chemicals with delusions of grandeur.”
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  #3  
Old 03-05-2013
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Default D) Magenetic Resonance Angiography (MRA)

D) Magenetic Resonance Angiography (MRA)
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  #4  
Old 03-08-2013
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Default D

Oculomotor palsy

Only D) Magenetic Resonance Angiography (MRA) makes sense
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  #5  
Old 03-09-2013
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D and is related I think to an aneurym. I need to check on that but clinical presentation and the options, D is a best option. I have to go read on this one.
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