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A 45-year-old, previously healthy, young woman presents with a CC of double vision x 1 week. Worse when she is looking horizontally to the right. She denies pain, loss of visual acuity, or other s/s.
PE: she demonstrates a loss of the normal paired movements of the eyes when tracking an object left or right. She also shows paralysis of the ocular muscles (internuclear ophthalmoplegia). The remainder of her neuro exam is unremarkable.
You order an MRI of the brain & spinal column and lumbar puncture.
The MRI is unremarkable except for one finding of “a lesion in the pontine tegmentum in the region of the medial longitudinal fasciculus.”  Â
The Lumbar puncture: positive for the presence of oligoclonal bands and an immunoglobulin G (IgG) index of 1.4 (normal <0.7). 1. Are there any referrals you would initiate for additional testing? SCIENCE HEALTH SCIENCE NURSING NURSING MS MN551