From the Neuroscience Institute (G.K., Brandi Baker, A.M.S.), Memorial Healthcare System; and Department of Diagnostic Imaging (Bruce Braffman), Memorial Regional Hospital, Hollywood, FL.
Neurology. 2022 Sep 20;99(12):524-530. doi: 10.1212/WNL.0000000000201013. Epub 2022 Aug 17.
A 51-year-old woman presented with a pressure-like headache behind her right eye and horizontal diplopia. On examination, she was unable to abduct or adduct the right eye but had intact vertical eye movements. Her deficits could not be overcome using the oculocephalic reflex. Imaging initially was interpreted as optic neuritis, but on careful review with radiology, a diffuse enhancing hyperintense signal within the orbital apex confirmed an orbital infiltrate. The focus of this case study is to review the localization approach for diplopia and build a differential diagnosis for orbital processes. Another key point is the importance of relying on the physical examination as the guide to a patient's management rather than imaging findings, which can often be misleading.
一位 51 岁女性以右眼后方的压迫性头痛和水平复视为主诉就诊。检查发现，她的右眼无法外展或内收，但垂直眼球运动正常。她的眼球运动障碍无法通过眼头反射克服。最初的影像学检查结果解释为视神经炎，但经放射科仔细复查，发现眶尖内弥漫性增强高信号证实为眶内浸润。本病例研究的重点是回顾复视的定位方法，并为眼眶病变建立鉴别诊断。另一个关键点是，依靠体格检查作为指导患者管理的方法，而不是影像学发现，这往往会产生误导。
