Loss of motor function of oculomotor nerve in DM - USMLE Forums
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Old 03-05-2013
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Default Loss of motor function of oculomotor nerve in DM

A 64 year old woman is evaluated in the emergency room for acute development of double vision and droopy left eyelid. She denies any fever or headache. Her past medical history is significant for diabetes mellitus and hypertension. On physical examination, she is afebrile and her blood pressure 132/88 mm Hg. Head and neck examination reveals ptosis of the left eyelid. Pupillary light reflex is intact . She can not adduct her left eye past the midline. The left 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.com/2011/07/face.jpg

Which of the following is the most likely eventual outcome of her condition?

A) Sub-arachnoid hemorrhage

B) Spontaneous resolution

C) Cerebellar ataxia

D) Persistent visual deficits

E) Aneurysmal Rupture
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Old 03-05-2013
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B would be the outcome.
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Internuclear ophthalmoplegia due to?

C
an't figure out the condition?
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Default D) Persistent visual deficits

D) Persistent visual deficits
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Thanks for the hint
Quote:
Paralysis of the oculomotor nerve, i.e., oculomotor nerve palsy, can arise due to:
In people with diabetes and older than 50 years of age, an oculomotor nerve palsy, in the classical sense, occurs with sparing (or preservation) of the pupillary reflex. This is thought to arise due the anatomical arrangement of the nerve fibers in the oculomotor nerve; fibers controlling the pupillary function are superficial and spared from ischemic injuries typical of diabetes. On the converse, a subarachnoid haemorrhage, which leads to compression of the oculomotor nerve, usually affects the superficial fibers and manifests as a palsy with loss of the pupillary reflex.
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Old 03-05-2013
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Quote:
Originally Posted by Novobiocin View Post
Thanks for the hint
its all in FA for step 1...if you read the neurology chapter there is a beautiful bulls eye diagram where its illustrated i have never forgotten...

However, this resolves spontaneously in majority of people!!

Mononeuropathy in DM resolves spontaneously in many..B is the answer
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