20 Yo African American Female With Sickle Cell Trait Complains Of Inability To Control Eyes - Page #1

Author: Adam Goldstone, MD
Co Author #1: R. Brian Bettencourt, MD
Co Author #2: Michael Linder, MD

Patient Presentation:
A 20 year old African American collegiate soccer player presents to her athletic trainer immediately following practice complaining that her eyes are crossed and she can't uncross them. The athletic trainer noticed ophthalmoplegia and upon phone consultation with the team physician transported her to the Emergency Room. On route, she developed dysarthria and left sided weakness.
She denies trauma, nausea, vomiting, photophobia, or loss of conciousness. She complains of a mild headache.

Past medical history was significant for sickle cell trait. There was no significant surgical or famiy history. The patient used Loestrin (norethindrone acetate and ethinyl estradiol) daily and no other medications. Social history was negative for drug, tobacco, or alcohol use. She was a junior and was a student athlete.

Physical Exam:
When she arrived to the Emergency Department her vitals were normal. (BP:124/85, HR: 91, RR: 16, T: 98.5, SaO2: 100% on RA)
Gen: She was alert, awake, no acute distress, and normal orientation.
Eyes: She had a normal ophthalmoscopic exam. Pupils were equal and reactive to light and accomadation.
CV: There were no carotid bruit. She had a regular rate and rythym. There were no murmurs or signs of trauma. She had normal pulses x 4 extremity's.
Resp: Lungs were clear to auscultation bilaterally.
Abd: Soft, non-tender, non-distended, and positive for bowell sounds.
MSK: She had normal gait, 4/5 stregth in the LUE and LLE and 5/5 strength in the RUE and RLE.
Neuro: She had mild dysarthria. Naming was intact, and she follows commands. There was a right gaze preference with difficulty passing midline. Positive for right sided horizontal nystagmus, left upper and lower facial weakness, left tongue deviation, and left sided neglect. Sensation, coordination, and deep tendon reflexeswere intact. Her NIH stroke scale was 11.

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