04-02-2006, 05:55 AM
A 45-year-old man presents to your office reporting diplopia in all directions. There is no eye movement abnormality to your examination. He describes some proximal muscle weakness, although strength testing in your office is normal. He complains that his jaw gets weak when eating steak. His jaw muscles and action are normal in your office. You are able to elicit vertical diplopia by making him look up with his eyes. The diplopia begins after 30 seconds. His examination is otherwise normal. He has a history of hypothyroidism. Bloodwork and brain MRI are entirely normal. What would you do next?
A. Write in his chart that he is malingering
B. Schedule him for a lumbar puncture
C. Consider Guillain-Barré syndrome
D. Schedule him up for an EMG/NCV study with repetitive stimulation, CT scan of the chest, and anti-acetylcholine receptor antibody level
A. Write in his chart that he is malingering
B. Schedule him for a lumbar puncture
C. Consider Guillain-Barré syndrome
D. Schedule him up for an EMG/NCV study with repetitive stimulation, CT scan of the chest, and anti-acetylcholine receptor antibody level