Slit Lamp Exam
Assess for Cataract
Lens symmetry
Posterior orbital mass
Macular dysruption
Consider ophthalmology consult
Consider ocular ultrasound
Assess for Cataract
Lens symmetry
Posterior orbital mass
Macular dysruption
Third nerve palsy: eye is down and out
Always needs CTH/CTA to rule out [[Posterior Communicating Artery (PCOM) Aneurysm|aneurysm given that nerve runs under PCA
Fourth nerve palsy: head tilt down and away from side of lesion
These are tough to catch and can be referred to ophtho outpatient for prisms
No imaging needed unless other deficits present
Sixth nerve palsy: eye can't track laterally
Children need imaging to r/o tumor
In > 50, m/l ischemic and can get MRI outpt or just watch, assuming no papilledema as it can cause isolated CN VI palsy
If other nerves/deficits noted, consider MRI and further wu
Other potential studies also include:
CTH with and without contrast ± CTA neck to rule out dissection and intracranial mass
MRV or CTV to eval for cavernous sinus thrombosis
CT orbits w/ contrast to eval for orbital apex syndrome (like CST above, but with CN II involvement)
MRI + DWI to if concern for CVA
MRI ± MRA if unable to classify intracranial process on initial contrast CT with contrast
MRI if concerned for MS
LP if concern for meningitis
Metabolic workup to rule out diabetes or cause of mononeuropathy
Always needs CTH/CTA to rule out [[Posterior Communicating Artery (PCOM) Aneurysm|aneurysm given that nerve runs under PCA
These are tough to catch and can be referred to ophtho outpatient for prisms
No imaging needed unless other deficits present
Children need imaging to r/o tumor
In > 50, m/l ischemic and can get MRI outpt or just watch, assuming no papilledema as it can cause isolated CN VI palsy
If other nerves/deficits noted, consider MRI and further wu
CTH with and without contrast ± CTA neck to rule out dissection and intracranial mass
MRV or CTV to eval for cavernous sinus thrombosis
CT orbits w/ contrast to eval for orbital apex syndrome (like CST above, but with CN II involvement)
MRI + DWI to if concern for CVA
MRI ± MRA if unable to classify intracranial process on initial contrast CT with contrast
MRI if concerned for MS
LP if concern for meningitis
Metabolic workup to rule out diabetes or cause of mononeuropathy
Diplopia
Cataract
Tinnitus
Lens dislocation
Dizziness
Macular disruption
Cataracts
Basilar Artery Thrombosis