Department of Family and Community Medicine, The Ohio State University College of Medicine & Wexner Medical Center, Westerville robert.gotfried@osumc.edu
DEPARTMENT EDITOR Richard P. Usatine, MD University of Texas Health at San Antonio
The author reported no potential conflict of interest relevant to this article.
A motorcycle accident precipitated by a health emergency led to loss of eye function. Advanced imaging revealed the diagnosis.
A 45-year-old woman visited the clinic 6 weeks after having a stroke while on her motorcycle, which resulted in a crash. She had not been wearing a helmet and was uncertain if she had sustained a head injury. She said that during the hospital stay following the accident, she was diagnosed as hypertensive; she denied any other significant prior medical history.
Following the crash, she said she’d been experiencing weakness in her right arm and leg and had been unable to open her right eye. When her right eye was opened manually, she said she had double vision and sensitivity to light.
On exam, the patient had exotropia with hypotropia of her right eye. Additionally, she had anisocoria with an enlarged, nonreactive right pupil (FIGURE 1A). She was unable to adduct, supraduct, or infraduct her right eye (FIGURE 1B). Her cranial nerves were otherwise intact. On manual strength testing, she had 4/5 strength of both her right upper and lower extremities.
WHAT IS YOUR DIAGNOSIS? HOW WOULD YOU TREAT THIS PATIENT?
