Clinical Reasoning: A 73-Year-Old Man With Progressive Proximal Muscle Weakness and Binocular Diplopia
Karl J Wold1, Armand Amini2, David Bargiela1
1Department of Neurology, Mass General Brigham, Boston, MA; and.
Neurology
|September 15, 2025
Summary
This case study highlights a 73-year-old man with progressive weakness and binocular horizontal diplopia. A detailed history and physical examination were crucial for diagnosing the unifying neurological process.
Area of Science:
- Neurology
- Ophthalmology
Background:
- Progressive weakness and diplopia present a broad differential diagnosis.
- Distinguishing between a single unifying process and separate causes is critical for accurate diagnosis.
Purpose of the Study:
- To review a case of progressive weakness and diplopia in an elderly male.
- To emphasize the importance of clinical history and physical examination in diagnosing neurological conditions.
Main Methods:
- Case report of a 73-year-old man.
- Detailed clinical history focusing on symptom progression and associated features.
- Thorough physical examination.
Main Results:
- The patient presented with proximal weakness (lower > upper extremities) followed by binocular horizontal diplopia.
- Diagnostic approach was guided by the rate of progression and symptomatology.
Conclusions:
- A comprehensive evaluation, including detailed history and physical exam, is essential for diagnosing complex neurological presentations.
- Careful assessment can differentiate between single and multiple underlying pathologies causing weakness and diplopia.
More Related Videos
07:00Eye-Tracking Control to Assess Cognitive Functions in Patients with Amyotrophic Lateral Sclerosis
Published on: October 13, 2016
8.7K
11:12Driving Simulation in the Clinic: Testing Visual Exploratory Behavior in Daily Life Activities in Patients with Visual Field Defects
Published on: September 18, 2012
17.8K
Related Concept Videos
01:22Photoreceptors and Visual Pathways
8.8K
At the molecular level, visual signals trigger transformations in photopigment molecules, resulting in changes in the photoreceptor cell's membrane potential. The photon's energy level is denoted by its wavelength, with each specific wavelength of visible light associated with a distinct color. The spectral range of visible light, classified as electromagnetic radiation, spans from 380 to 720 nm. Electromagnetic radiation wavelengths exceeding 720 nm fall under the infrared category,...
8.8K
01:15Myasthenia Gravis: Diagnostic Tests
1.9K
Myasthenia gravis is an autoimmune condition affecting neuromuscular transmission, causing generalized weakness in skeletal muscles. Initial diagnoses rely on patients' signs, symptoms, and medical history. The challenge lies in distinguishing myasthenia from other muscular dystrophies. An important diagnostic feature is the significant improvement of symptoms after administering anticholinesterase inhibitors.
The edrophonium test is a diagnostic tool for myasthenia gravis. It involves...
The edrophonium test is a diagnostic tool for myasthenia gravis. It involves...
1.9K
01:17Accessory Structures of the Eye
3.4K
Optical perception, or vision, is an extraordinary sense dependent on converting light signals received via the ocular organs. These organs, known as eyes, are securely positioned within the bony cavities of the skull, called orbits. The orbits serve a dual purpose: a protective shield for the ocular globes and a stable attachment point for the soft ocular tissues. The eye's external protective mechanisms include the eyelids, which are edged with lashes that act as a barrier against foreign...
3.4K
01:28Disorders of the Skeletal Muscle
1.7K
The clinical conditions affecting the skeletal muscle tissue are broadly categorized as musculoskeletal and neuromuscular disorders.
Musculoskeletal disorders
Musculoskeletal disorders involve injuries and conditions affecting the skeletal muscles and associated connective tissues. These disorders can arise from acute biomechanical stresses or chronic overuse and can occur across different age groups. Common injuries include sprains, fractures, and muscular strains, often resulting from...
Musculoskeletal disorders
Musculoskeletal disorders involve injuries and conditions affecting the skeletal muscles and associated connective tissues. These disorders can arise from acute biomechanical stresses or chronic overuse and can occur across different age groups. Common injuries include sprains, fractures, and muscular strains, often resulting from...
1.7K
01:25Glaucoma: Overview
1.3K
Glaucoma is an eye condition characterized by increased intraocular pressure that damages the retina and optic nerve, leading to irreversible blindness if left untreated. The human eye has various components, including the cornea, iris, pupil, lens, and optic nerve. Aqueous humor is secreted by the epithelium of the ciliary body in the posterior chamber and flows through the trabecular meshwork and canal of Schlemm, maintaining normal intraocular pressure. The trabecular meshwork and the canal...
1.3K
01:20Myasthenia Gravis: Overview and Treatment
2.8K
Myasthenia gravis is a neuromuscular transmission disorder characterized by weakness and increased fatigability of skeletal muscles. It is an autoimmune disease affecting approximately one in 2000 people, where antibodies against the α1 subunit of nicotinic acetylcholine receptors are produced.
These antibodies interfere with the function of the nicotinic receptors in three ways: by binding to the receptor and disrupting acetylcholine binding; by causing cross-linking of receptors which...
These antibodies interfere with the function of the nicotinic receptors in three ways: by binding to the receptor and disrupting acetylcholine binding; by causing cross-linking of receptors which...
2.8K