Differential Diagnosis of Recent & Longstanding Palsies Flashcards
What can’t we differentiate between longstanding, congenital and acquired?
Cannot differentiate between congenital and longstanding acquired
What can we use to differentiate between congenital/longstanding/acquired?
- Case History
- Questioning around symptoms
- Old photographs
- Look at prescription - focimeter them
What are the red flags we think about during case history for something being acquired?
- Report exact cause
- Recent head trauma
- Aware of AHP
- Coincidental family history
- Possible previous episode that has recovered
What are the red flags we think about during case history for something being longstanding?
- No obvious cause
- Head trauma from past
- Unaware of AHP
- Familial cases of CNIV palsy
- Attended as a child
- Possible facial asymmetry
What are the symptoms that bring up a red flag for something being acquired?
- Sudden onset
- Diplopia
- Troubled by symptoms
- Torsion CNIV palsy
What are the symptoms that bring up a red flag for something being acquired?
- Vague onset
- Diplopia absent/intermittent
- Not troubled by symptoms
- Symptoms worse when tired (can be related to ability to control)
What can we observe that brings up red flags for a palsy being acquired?
- Aware of new AHP
- AHP resolves when occluding one eye or in the dark
What can we observe that brings up red flags for a palsy being acquired?
- May have AHP from childhood (photos)
- AHP maintained on occlusion of one eye or in the dark
What are we more likely to see on CT in an acquired palsy?
- Incomitant deviation
- Small deviation for degree of symptoms
What are we more likely to see on CT in a longstanding palsy?
- Fairly concomitant deviation
- May be controlling large phoria
What are we more likely to see during VA in an acquired palsy?
- Any reduction in VA is generally coincidental
- Rare has an associated cause except pressure on optic nerve from a tumour or previous retrobulbar neuritis etc.
What are we more likely to see during VA in a longstanding palsy?
- Amblyopia if manifest from an early age
- Reduced VA could be cause for decompensation (can be common in cataract development)
What are we more likely to see on OM in an acquired palsy?
- Incomplete muscle sequelae (CNIII is an exception)
- Incomitant on Hess Chart
What are we more likely to see on OM in a longstanding palsy?
- Muscle sequelae developed (may have difficulty identifying originally affected muscle)
- Hess chart shows fields of similar size
What are we likely to find during binocular functions in acquired palsies?
- Normal vertical fusion range (if no constant diplopia)
- No suppression (unless childhood strabismus or elderly and ignoring the diplopic image)