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Answers: 2007 series -  May 15, 2007 Lecture 33 of 52  NEXT»

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This 5-year-old boy walks into the examination room looking like the picture above.

1.  Looking at this boy you suspect that he has:   
 

e -- all of the above

This head posture could be present with any of these diagnoses.

 

2.  A good plan for the first thing to do when commencing the exam would be: 
 

c -- straighten the child’s head and look at the alignment

If the examiner puts a hand on the patient's head and gently but forcibly straightens the head, lots of information can be obtained.  If the neck muscles are tight, this will be obvious because the neck will look different on the side of the tilt and the head may not fully straighten.  If the patient is achieving a null point, nystagmus will begin or increase when the head is straightened. With a Brown, the right eye will probably be hypodeviated.  With an inferior oblique palsy there would also be a right hypo, but it would probably be less.  Differentiating a Brown from an inferior oblique palsy is done by noting restricted elevation in adduction present with a Brown.  This would be done in the operating room with anesthesia.

 

3.  Regardless of diagnosis, the most likely treatment would be:
 

a -- surgery

With any of these diagnoses the most likely treatment would be surgical with the surgery specifically dealing with the pathology.

 


These pictures show a right hypotropia and limited elevation in adduction most often seen in Brown syndrome.  This would be confirmed by carrying out the forced duction test.

 

 


Lecture 33 of 52 «Previous Lecture   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52    Next»
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