Cranial Nerve Disorder – Clinical Patient Case of the Week

Andrea Eberly, MD, MS, FAAEMClinical Pearls, Emergency Medicine, Family Medicine, Guideline Knowledge Check, Internal Medicine, Nurse Practitioner, Nursing RN/PN, Pediatric Emergency Medicine, Pediatric Medicine, Personal Education, Physician Assistant, Urgent Care

Cranial Nerve Disorder - Clinical Patient Case of the Week

Cranial Nerve Disorder - Clinical Patient Case of the Week

Try this free Cranial Nerve Disorder Case Q&A courtesy of Med-Challenger.

This abdominopelvic disorders case comes from our Family Medicine Exam Review and CME Course, part of Med-Challenger's library of board exam review and CME question banks.

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Try this case and test your knowledge of cranial nerve disorders.

A 38-year-old woman without past medical history presents to you with a rapid-onset headache. This headache is not the worst of her life.

You note that the patient has her head tilted to the left on your initial inspection. When asked, she states that when she holds her head straight, she has diplopia. Further examination reveals the inability to move the eye downward and laterally, indicating a trochlear (fourth cranial nerve [CN-IV]) palsy.

There is no other neurologic deficit or papilledema present. Because isolated CN-IV palsy is usually traumatic, you ask the patient about this but she denies any injury. Her blood glucose is normal and a pregnancy test is negative.

Computed tomography reveals no pathology. A "champagne tap" lumbar puncture shows no xanthochromia.

Question:

The most likely diagnosis is...

Answer Options:

ammonia poisoning

central venous thrombosis

Cotard delusion

malingering syndrome

See the Answer:

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