A 75-year-old woman presented with horizontal binocular diplopia, right-sided ptosis, and a new headache that was progressive over 3 days. She reported difficulty opening her jaw, pain when chewing, and a 2.3-kg weight loss. The week prior, she experienced left-sided ptosis that persisted for 2 days and subsequently resolved. She denied vision changes, eye pain, scalp tenderness, and myalgias. Past medical history included schizophrenia, hypothyroidism, and supraventricular tachycardia.
Please finish quiz first before checking answer.
Read the answer below and download your certificate.
Read the discussion below and retake the quiz.
A. Giant cell arteritis
Facial and extraocular muscles are typically spared by the myositis associated with aminoacyl transfer RNA synthetase antibodies, and the lack of other features of antisynthetase syndrome (interstitial lung disease, nonerosive arthritis, Raynaud phenomenon) makes this diagnosis less likely. Immunoglobulin G4–related disease can cause enlargement of the extraocular muscles, creating a restrictive pattern of motility but may also be accompanied by hypertrophic pachymeningitis and sclerosing lesions of the abdomen and lungs. Lastly, although the history of transient contralateral ptosis may be reminiscent of myasthenia gravis, the lack of fatiguability, normal ice-pack test results, and soft tissue changes on magnetic resonance imaging suggest an alternate etiology.
Sign in to take quiz and track your certificates
JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 Credit(s)™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC
CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Corresponding Author: Jeannette Y. Stallworth, MD, Department of Ophthalmology, University of California, San Francisco, 490 Illinois St, 5th Floor, Room 5X8, San Francisco, CA 94143 (email@example.com).
Published Online: July 25, 2022. doi:10.1001/jamaneurol.2022.1982
Conflict of Interest Disclosures: None reported.
Additional Contributions: We thank the patient for granting permission to publish this information.
You currently have no searches saved.
You currently have no courses saved.