Too Sleepy to Look Up
neuro ophthalmology
Patient Demographics
Age: 22 years
Gender: Female
History of Presenting Complaint
Headaches, followed by sudden onset of sleepiness and increasing difficulty to rouse, prompting emergency assessment and neuro-imaging.
Past Medical History
- No significant past medical history reported
Examination Findings
Visual Acuity
OD: 6/6. OS: 6/6 (gross assessment; formal testing limited by reduced conscious level)
Pupils
No pupillary response to light, but intact near reaction (light-near dissociation)
Extraocular Movements
No upgaze; convergence-retraction nystagmus on attempted upward gaze
Anterior Segment
Lids: bilateral eyelid retraction noted on clinical photography (Collier's sign)
Posterior Segment
Level of consciousness: GCS 13/15 (E3 V4 M6) — drowsy, rousable to voice, mildly confused
Which investigations would you choose?
Try to decide before revealing the results. You have 2 attempts.
Urgent CT brain
Serum and CSF tumour markers (AFP, beta-hCG)
MRI brain with contrast
Histopathology of the resected lesion
Overnight polysomnography
0 of 4 investigations selected
Investigations (Locked)
Complete the investigation selection question above to unlock the full investigation results.