I'd do a chest X ray.
Mark Slade
Consultant in General Medicine
Oxford
-----Original Message-----
From: John Ryan [mailto:[log in to unmask]]
Sent: 09 October 2001 22:23
To: [log in to unmask]
Subject: Isolated 6th nerve palsy
A 48 year old, cigarette smoking, otherwise well, lady presents with a 3 day
history of diplopia which was preceded by unilateral headache for 2 days,
resolving with onet of diplopia. Examination reveals a marked lateral
rectus palsy on the right side and she has already patched the eye to
prevent diplopia. Examination is otherwise completely normal. Blood sugar
and BP normal, nothing to suggest demyelination or auto immune pathology.
Would you ?
1) Arrange urgent CT
2) Arrange urgent MRI
3) Referr to neurology OPD, (next available appointment in a future era)
4) Discharge her telling her many of these resolve after 3 months (as per
Tintanelli !)
5) Some other bright idea ?
John Ryan
Dr John Ryan
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