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Can Fam Physician. 2010 October; 56(10): 1023.
PMCID: PMC2954084

Question: Can you identify this condition?

An external file that holds a picture, illustration, etc.
Object name is 1023-afig1.jpg

A 64-year-old woman with a past medical history of type 2 diabetes mellitus, hypertension, dyslipidemia, depression, and osteoporosis presents with a 2-week history of binocular horizontal diplopia. Her past ocular history includes diabetic retinopathy and cataract extraction. She admits to a 75-pack-year smoking history. She has no other neurologic symptoms and no history of cancer. On examination, visual acuity, pupillary testing, intraocular pressure, and slit-lamp examination results are all within normal limits. Fundus examination reveals nonproliferative diabetic retinopathy. Extraocular muscle testing reveals the above images.

The most likely diagnosis is

  1. Oculomotor nerve palsy secondary to microvascular ischemia
  2. Oculomotor nerve palsy secondary to intracranial mass lesion
  3. Abducent nerve palsy secondary to microvascular ischemia
  4. Abducent nerve palsy secondary to intracranial mass lesion

Answer on page 1027


Articles from Canadian Family Physician are provided here courtesy of College of Family Physicians of Canada