A 62-year-old woman with a history of diabetes and hypertension presents to the emergency room with her right eye deviated outward and an obvious ptosis. The pupils are normal size. She has a slight headache Which of the following is the most likely diagnosis?
سؤال مجاني 2 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
الإجابة: A. Vasculopathic third nerve palsy
Ptosis with the eye deviated down and out but a normal pupil in a diabetic/hypertensive patient = pupil-sparing (vasculopathic) CN III palsy. Ischemia of the vasa nervorum spares the peripheral parasympathetic pupillary fibres. An aneurysm compressing CN III (D) typically affects the pupil (dilated). Superior oblique palsy and INO do not cause ptosis.
ليش كل خيار صح أو غلط
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A
ليش صح
In CN III palsy from small-vessel disease the parasympathetic fibres are intact, so the pupil is spared (normal size, reactive); this fits a diabetic and hypertensive patient.
✓ 11• Diabetes Mellitus [Notes].pdf · p. 7 -
B
ليش غلط
Ptosis with an eye turned out is explained by a CN III palsy (levator weakness plus unopposed lateral rectus), not by an internuclear lesion.
✓ 11• Diabetes Mellitus [Notes].pdf · p. 7 -
C
ليش غلط
The ptosis and outward-deviated eye here are explained by CN III palsy (levator weakness plus unopposed lateral rectus), not by a superior oblique palsy.
✓ 11• Diabetes Mellitus [Notes].pdf · p. 7 -
D
ليش غلط
Compression of the oculomotor nerve can cause pupillary dilation by injuring the parasympathetic fibres; her pupils are normal, which fits microvascular (diabetic) palsy instead.
✓ Neurology ⌛️.pdf · p. 16
- المصدر
- 11• Diabetes Mellitus [Notes].pdf · p. 7
Step Up To Medicine 6th Edition 2024 (DM).pdf · p. 13 - المحاضرة
- Diabetes Mellitus · Endocrinology · Module B
- ظهر في
- Endo bank