A 65-Year-Old Man With Diplopia and a Drooping Eyelid

Sumaira Nabi, MBBS; Sadaf Khattak, MBBS; Mazhar Badshah, MBBS, MD, FCPS

Disclosures

August 21, 2019

Editorial Note: The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.

Background

A 65-year-old man presents to the emergency department with a 20-day history of sudden, severe, sharp, right-sided retro-orbital pain. The onset of pain was followed two days later by diplopia in all directions of gaze (without visual loss) and by tingling on the upper half of the right side of the face; after an additional two days, the patient developed drooping of his right eyelid.

He reports no history of any other such episode or of fever, joint pains, rash, or weight loss. The patient is a mason with five children. He does not use tobacco or other substances. He has had hypertension for the last 11 years and is well controlled on tablet lisinopril 10 mg once daily. The family history is unremarkable.

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