ABSTRACT
A 52-year-old man presents to the ophthalmologist with a past medical history of diabetes type II, asthma, hyperlipidemia, coronary disease with prior stent placement, and chronic low back pain. He also has a 50 pack/year history of tobacco use. Three days ago he began noticing that his right upper eyelid was droopy and that he was experiencing double vision. The ptosis progressed and is now almost complete. He is complaining of global headache, without nausea or vomiting. On examination, there is mydriasis OD with partial ptosis of the right upper lid. Ocular motility revealed on the right side, a -4 adduction deficit and a -3 elevation and depression deficit (Figure 12.1). He was seen at an outside hospital 2 days ago and an MRI/MRA were reportedly “normal”.
