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Clinical Review & Education JAMA Ophthalmology Clinical Challenge Alexander T. Nguyen, MD; Louise Resor, MD; Robert L. Lesser, MD A B Figure. A, A computed tomographic scan of the face and orbits in coronal sections demonstrating inflammatory changes in the maxillary and ethmoid sinuses without orbital involvement. B, An axial computed tomographic scan does not show inflammatory involvement of the petrous apices (digitally processed image). A indicates anterior. An 18-year-old man presented with an upper respiratory tract infection that persisted for a week without improvement. Because of this infection, he went to an emergency depart- WHAT WOULD YOU DO NEXT? ment and was prescribed antibiotics for presumed sinusitis. Five days later, he developed painless horizontal diplopia and returned to the emergency department. Findings from a A. Perform a serum test for computed tomographic scan showed diffuse sinusitis autoantibodies that was procedurally drained by an otolaryngologist. Quiz at However, this treatment did not resolve the diplopia and B. Perform a tensilon test jamaophthalmology.com he was subsequently referred to a neurologist. Addi- tional evaluation included a repeated computed tomo- C. Perform magnetic resonance graphic scan that showed no infectious involvement of the orbits or petromastoid com- venography plexes (Figure). Findings from
JAMA Ophthalmology – American Medical Association
Published: Jul 1, 2015
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