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Course: Ophthalmoplegia With Isolated Extraocular Muscle Hypertrophy

CME Credits: 1.00

Released: 2024-01-08

A 60-year-old man presented with a 1-week history of progressive painless diplopia. He had a history of hypothyroidism and dyslipidemia, for which he took levothyroxine and rosuvastatin. He reported no changes in visual acuity or color vision; no ocular pain, erythema, or abnormal discharge; and no headaches, scalp tenderness, jaw claudication, ptosis, dysphagia, dysarthria, weakness, numbness, or ataxia. He did not have any constitutional or systemic symptoms. Physical examination showed an isolated limitation of right eye abduction. The remainder of the examination, including visual acuity, pupillary reaction, visual fields, and fundoscopy, was unremarkable. A magnetic resonance image (MRI) of the head showed abnormal thickening and T2 hyperintensity of the right lateral rectus muscle with T1-weighted gadolinium enhancement (Figure 1). Tests for infection and autoimmune disease had negative results. Computed tomography of the abdomen and pelvis did not demonstrate any evidence of malignancy.


Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.


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