kiranmayi
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A 14-year-old male adolescent visits his primary care physician because of double vision that has lasted 10 days. He says that he sees 2 images that are vertically separated and that the distance between the 2 images increases as he looks upward. The double vision disappears when he looks down or closes either eye. No associated neurologic signs or symptoms are present. Examination reveals that the left eye does not move up when the patient attempts to look upward. What is the diagnosis?
Hint
About 2 weeks ago, the patient was hit in the left eye with a softball, and he had some bruising of the eyelids.
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| asmi
Forum Hero
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sounds like orbital blowout fracture with entrapment of extraocular muscle(inferior rectus,inferior oblique) :?:
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| SDK
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try this tricky Qs!!!!!!
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| vic2005
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some hematoma compressing inferior oblique?
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| gpsbrar
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Depends from which position he cannot elevate the eye.
Superior rectus can elevate and adduct the eye from the Neutral poisition. BUT IT FROM THE ABDUCTED POSITION IT IS THE ONLY MUCLE THAT CAN ELEVATE THE EYE.
Inferior oblique can elevate the eye and abduct the eye from the neutral positon. BUT FROM THE ADDUCTED POSITION IT IS THE ONLY MUSCLE THAT CAN ELEVATE THE EYE.
So this proves that the damage is to the CN 3. Occulomotor lesion. It is compressed due to some artery or something which I cannot think right now.
But please chk too. And if wrong please correct it.
Edited by gpsbrar on 08/11/05 - 03:27 PM. Reason: Incomplete reasoning
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| vic2005
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I do not think that is a complete palsy of the III because he does not have other symptons related , like external strabism .I think it is one muscle involved in the injure .
So , what is the answer?????
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| ssrpk
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i agree, does'nt seem like a omplete CN III damage otherwise anisocoria would have been present! must be some muscle injured! not sure though!
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| Elnajjar
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this is a case of fractured orbital floor with entrapment of inferior oblique which is not only doesn't do its work but also acting as a leash that prevents SO from elevating the globe.
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| gpsbrar
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hummm I never thought that way. Thanks Najjar.
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