The Clinical Problem Solvers Episode 419: Neurology VMR – Headache and diplopia
Sep 11, 2025
Dive into the perplexing world of neurology as experts tackle a case featuring a patient with headaches and diplopia. They explore the intricate connections between neurological symptoms and conditions like rheumatoid arthritis. Key discussions highlight the importance of thorough history-taking, critical lab tests, and innovative diagnostic processes. The conversation also delves into complex treatment decisions surrounding autoimmune disorders, ensuring an informative blend of patient care and medical reasoning. Perfect for anyone intrigued by the mysteries of the brain!
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Act On Red Flags In Headache
- Get urgent ophthalmologic and neurologic evaluation for headache with painful blurry vision and eye movement pain.
- Prioritize red flags (new focal vision symptoms, age >50, systemic signs) and escalate workup rather than assume primary headache.
Time Course + Localization Narrow Differential
- Use time course and localization to narrow neurologic differentials: timing suggests inflammatory/infectious, localization suggests optic nerve and extraocular cranial nerves.
- Combine these axes early to focus testing on optic neuritis, cranial neuropathies, and cavernous/supraclinoid processes.
High-Yield Neuro Eye Exam
- Always examine eye movements, other cranial nerves, and perform a fundoscopy when vision or diplopia is reported.
- Lack of papilledema does not exclude posterior optic neuritis, so pursue targeted orbital MRI if suspicion remains.
