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Answers: 2004 series -  January 27, 2004 Lecture 49 of 50  NEXT»

 

    5-year-old patient  

This 5-year-old child has the appearance shown here when attempting to look up and to the right. 

1.   The most likely diagnosis is:

a
-- This is the clinical picture of congenital Brown syndrome.  This is a more extreme hypodeviation than would be expected with inferior oblique palsy.
 
2.   The course of the above is most likely: 

b -- Brown syndrome has several specific causes which all have in common a mechanical restriction to elevation in adduction. 

3. The most likely head posture for this patient is:

c
-- The most common head posture in Brown syndrome is chin up with the face pointing in the direction where the eyes cannot look with alignment.  The eyes look down and in the opposite direction of the limitation of movement in the involved eye.  With the eyes looking down and to the opposite side of the limited movement, the patient has the best chance to avoid diplopia and gain fusion.
  


Lecture 49 of 50 «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    Next»