Abstract

A previously healthy 25-year-old man presented with a 3-weeks history of frontal headache, right-sided ptosis and binocular horizontal diplopia. The diagnosis of right 3rd nerve palsy was made. Magnetic Resonance Imaging/angiography (MRI/A) of the brain was interpreted as normal. Two days later, right facial droop and weakness developed along with lower back pain, paresthesias of both legs and left leg weakness. On exam, he had bilateral upper lid ptosis, bilateral adduction deficits and areflexia of the left patella with bilaterally decreased ankle reflexes. It was concluded that he now has bilateral partial pupil-sparing left 3rd nerve palsies and right peripheral 7th nerve palsy.