Spot Dx — Can you lift the lid on this diagnosis?
A 59-year-old woman with poorly controlled hypertension presents with sudden-onset right eyelid drooping lasting one day.
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A 59-year-old woman with poorly controlled hypertension presents with sudden-onset right eyelid drooping lasting one day.
She complains of diplopia on left gaze and dull right periorbital pain. Intermittent throbbing headache is also noted.
Earlier that day, she visited another hospital, where a non-contrast cranial CT read as negative.
On physical examination, doctors observe severe right-sided ptosis, measuring 8mm (see figure 1), and mydriasis of 5mm, with sluggish reaction to light and a downward, lateral deviation of the right eye.
She has intact muscular strength and normoreflexia.
