(BMJ) – A 51-yo woman w/ no PMHx sustained a head injury w/ brief LOC during a car crash. She c/o headache, dizziness, and diplopia. Exam: Loss of medial gaze of right eye; no evidence of facial trauma. CT head/face/orbits was normal. What is the diagnosis?
Venous sinus thrombosis
Acute infarct of right medial longitudinal fasciculus
Orbital rim fracture
Multiple sclerosis
Cerebellar hemorrhage
You are correct. Orbital and skull fractures were excluded by CT scan. Subsequent brain MRI demonstrated an acute infarct of the right medial longitudinal fasciculus (MLF). Internuclear ophthalmoplegia (INO) is an impaired conjugate gaze characterized by adduction paresis of the affected eye and abduction nystagmus of the contralateral eye, leading to horizontal diplopia. It usually occurs in multiple sclerosis or cerebrovascular disease, and is extremely rare after head injury. INO may persist for months. This patient received conservative tx and recovered within 3 days.
(BMJ) - A hairdresser who frequently wears open-toed shoes presented w/ a lesion on her foot between her toes. Blonde, red, brown, and grey hairs protruded from the lesion. The image shows the area before and after tx. What is the diagnosis?
Hidradenitis suppurativa
Dermoid cyst
Interdigital pilonidal sinus
Squamous cell carcinoma
Folliculitis
You are correct. Interdigital pilonidal sinus is an occupational disease that usually affects hairdressers’ hands; few cases have been described affecting the feet. Freshly cut hairs are able to penetrate the skin and start the disease process. The condition may be prevented by avoiding exposure of the interdigital skin to freshly cut hair. Treatment is by surgical excision.