By Ivan S. Login, MD
University of Virginia Health System
When evaluating a person with dysconjugate gaze one very helpful insight can be a review of historical patient photographs to try dating the onset of the problem. Routinely, we may depend on a state driver's license as a commonly available photo at an initial visit. However, obtaining pictures beyond a driver's license at an initial visit can be challenging.
An adult patient presented with uncontrolled headaches and evidence of left lateral rectus weakness plus a subtle head deviation toward the left. The patient thought "something was wrong with my eyes" from earliest childhood. The accuracy of these memories could have had a significant influence on decisions about the presenting headaches.
During our initial visit, the only available historical image was a state driver's license from the current year which demonstrated signs similar to the office examination. I pointed out the anatomically important issues so the patient knew our concerns. In customary fashion I asked the patient to comb through old personal and family photos as far back as possible and mail the clearest of them to me for careful review.
The patient, in turn, asked if the exam room computer monitor was connected to the Internet and if so, might they log on. The patient immediately accessed their Facebook site and proceeded to show us a series of perfect personal photographs from childhood to the present. Every image nicely depicted the same dysconjugate gaze and compensatory head turn. Further inquiry established the early diagnosis of Duane’s syndrome.
Facebook, and others of its ilk, may be a spectacular resource for scholarly investigation that can assist diagnostic challenges in many realms of neurology. Besides dysconjugate gaze and torticollis, one might anticipate possible insights about anisocoria, dystonic postures, atrophic muscles, and with audio/video options, speech and language dysfunction and movement disorders. The pervasive use of the electronic medical record might actually permit us to import or upload such images and video right into the patient's "chart" for future reference. Thus, it may be valuable to remain vigilant about these resources and remember to ask patients about potential medical data lurking on the Internet.
Dr. Login reports no disclosures.