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EM@3AM: Retrobulbar Hematoma

A 35-year-old male presents with left eye pain and vision loss after an unwitnessed altercation. On exam, there is significant left periorbital edema and ecchymosis; the left eye appears mildly proptotic. He is unable to open the eye unassisted due to swelling and pain. His left eye has conjunctival injection, chemosis, and a dilated pupil, which is non-reactive to direct light but constricts in response to light shone in the contralateral eye. The patient is unable to participate in extraocular testing secondary to pain and distress. Intraocular pressures are 18 on the right, 42 on the left.

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EM@3AM: Cortical Hand-Knob Stroke Mimicking Peripheral Nerve Injury

A 95-year-old man presents after waking with sudden inability to move the fingers and thumb of his right hand. He can lift his arm, flex and extend his wrist normally, and reports intact sensation. He denies numbness, facial droop, dysarthria, headache, gait disturbance, chest pain, or dyspnea. He has 0/5 strength in finger flexion and extension as well as in the intrinsic hand musculature, with preserved proximal upper extremity strength and intact sensation. He has no other appreciable deficits and normal vital signs. What is the diagnosis?

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