A 25-Year-Old Man With Painless Diplopia

Sumaira Nabi, MBBS, FCPS; Shahzad Ahmed, MBBS; Fateen Rashid, MBBS; Mazhar Badshah, MBBS, FCPS

Disclosures

August 09, 2016

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case you would like to suggest for a future Case Challenge, please contact us.

Background

A 25-year-old Pakistani man presents to the emergency department with a 7-day history of gradual-onset, painless diplopia in the left lateral gaze. One year prior to this presentation, he had vision loss in his left eye, with partial recovery over 4 weeks. Upon further inquiry, he also recalls an episode of right-sided ataxia 6 months before presentation, which completely remitted in 2 weeks.

The patient reports no history of fever, joint pains, rash, or weight loss. He is single and a mason by occupation. He has no history of travel abroad or sexual contact. He is a nonsmoker and denies substance abuse. The family history is unremarkable.

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