Whats wrong with the Eyes?

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Whats wrong with the Eyes?

Post  Abbas on Thu Nov 25, 2010 9:22 pm

A 37 year old man presented with a double vision. His wife stated
that his neck seems to be in spasm as he is always tilting his head towards the left
side like this:


He denied any pain or spasm in his neck muscles. Your colleague who is sitting
beside you told him to tilt his head towards the right side, and you noticed
something:


What do you notice?
a. Dropping of the left eye brow.
b. Dropping of the right upper eye lid.
c. Contraction of the frontalis muscles.
d. Slight elevation of the right pupil.
e. Excessive tearing.

Abbas

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Re: Whats wrong with the Eyes?

Post  Dr.Hunain(admin) on Mon Nov 29, 2010 8:01 pm

Slight elevation of right pupil

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Why right pupil is elevated

Post  Abbas on Wed Dec 01, 2010 5:46 pm

Good observation, but why right pupil is elevated? Read the answer

This acquired head tilting, with positive Beilschowsky sign ( ie slight elevation of the pupil upon titling the head towards the ipsilateral side), with an increase in double vision, is highly characteristic of 4th cranial nerve palsy causing weakness of superior oblique muscle. He has right sided 4th cranial nerve palsy.

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Re: Whats wrong with the Eyes?

Post  Dr.Hunain(admin) on Wed Dec 01, 2010 8:02 pm

Is it because of the un-opposed pull of the inferior oblique muscle on the ipsilateral side?

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