Question
A 22-year-old man presents to the emergency department with a 1-day history of diplopia. Examination reveals limitation of abduction of the right eye and limitation of elevation of the left eye. The pupils measure 7 mm (RE) and 8 mm (LE) with poor reaction to light and accommodation. Bilateral ptosis is present. The least useful test needed to confirm the diagnosis is:
| A. |
Clostridium botulinum toxin test
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| B. |
tensilon test
|
| C. |
lumbar puncture
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| D. |
GQ1b antibody test
|
Show Answer
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Correct Answer � B
Explanation
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|
Answer: B. Tensilon test
Explanation: Tensilon test is useful in diagnosing myasthenia gravis. Pupil involvement however is not seen in myasthenia. The differential of motility deficit with pupil involvement includes Guillain– Barré syndrome and botulism. Guillain–Barré syndrome is an autoimmune disease following an infection or recent immunization. It presents as an acute polyneuropathy with ascending paralysis. The Miller–Fisher variant of Guillain–Barré syndrome presents with ataxia, areflexia, and ophthalmoplegia with pupil involvement. Lumbar puncture may reveal elevated protein, and anti-GQ1b antibodies are often present. Botulism may also present with ophthalmoplegia and pupillary involvement. Testing for toxins or organisms in the blood, stool, food, or a wound helps confirm the diagnosis.
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