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Electronic MedCase from emedicine.com
BACKGROUND
An 82-year-old man presents to the clinic with
progressive difficulty swallowing and dysphagia over
the last several weeks. He has been unable to eat food
or drink water for the last 6 days and is thirsty. He
denies odynophagia but reports that his speech has
become slurred concurrently with his other
difficulties. He denies having motor or sensory
deficits, headache, fevers, urinary symptoms, malaise,
or fatigue.
On physical examination, the patient's vital signs are
normal with a heart rate of 78 beats per minute and a
blood pressure of 132/67 mm Hg. Pulse oximetry is 98%
on room air. He has slurred speech. Examination of the
head and neck reveals a normal oropharynx with intact
tongue movements and a preserved gag reflex. However,
the patient has bilateral, symmetric palpebral ptosis
with a masklike face. In addition, he has to tilt his
head back to look straight ahead. Because of an
inability to lift his eyelids, he seems to be
furrowing his eyebrows to compensate.
The patient has normal motor strength, including
strength in the extensors of his wrist and deltoids.
He has intact sensation in his extremities and
symmetric and normal deep tendon reflexes, and he can
walk with no pronator drift. The patient has no
difficulty breathing.
What is the diagnosis? |
Hint
The eyes have it. |
| Authors: |
Ryland
P. Byrd, Jr, MD, Chief of Pulmonary Medicine,
Medical Director of Respiratory Therapy,
Quillen Mountain Home Veterans Affairs Medical
Center; Professor, Department of Internal
Medicine, Division of Pulmonary Diseases and
Critical Care Medicine, James H. Quillen
College of Medicine, East Tennessee State
University
Ehab S. Kasasbeh, MD, The Veterans Affairs
Medical Center, Mountain Home, TN, and the
Department of Internal Medicine, James H.
Quillen College of Medicine, East Tennessee
State University
Kisa W. Seymore, MD, The Veterans Affairs
Medical Center, Mountain Home, TN, and the
Department of Internal Medicine, James H.
Quillen College of Medicine, East Tennessee
State University |
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| eMedicine
Editor: |
Rick
Kulkarni, MD, Attending Physician, Director of
Informatics, Department of Emergency Medicine,
Olive View - UCLA Medical Center, Assistant
Professor of Medicine, David Geffen School of
Medicine at UCLA |
|
Above case courtesy of
emedicine.com
Answer
to case
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