Pertinent Positives: + pain with eye movement, + decreased visual acuity, + APD
Pertinent Negatives: No recent fever, sinus pressure, rhinorrhea, neck trauma or rapid neck rotational force, floaters, field cut. No neurologic deficits consistent with stroke.
Given History and Exam I have a low suspicion for Uveitis, complicated sinusitis, stroke, carotid dissection, retinal detachment, CRAO, CRVO.
Workup: MRI brain and orbits [with gadolinium, plus fat suppression]
Consult: Ophthalmology and Neurology [Query steroids, plasmapheresis/PLEX, IVIG]
Interventions: IV methylprednisolone 1 g
Disposition: Admit
PEARLS:
Consider full ED vs outpatient workup:
- Labs
- CBC, CMP, ESR, CRP, RPR, FTABS
- (Consult with neuro regarding CSF and serum studies):
- Typically protein/glucose, gram stain/culture, cell count/differential
- Plus angioconverting enzyme, IgG indices, myelin basic protein, oligoclonal bands
- Plus SERUM IgG indices, oligoclonal bands, angioconverting enzyme, NMO antibodies
- Imaging
- Leif MRI nondiagnostic: to rule out neuromyelitis optica
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