A 52-year-old male patient who reported that his wife had noticed his right pupil was more dilated than the left. This had concerned her as he had presented with left-sided facial weakness and unequal pupils three years earlier following a transient ischaemic attack (TIA). He remembered that a CT scan of his brain had been normal, though an MRI scan of his neck had shown some slight abnormality. He felt that the left side of his forehead had never been 'quite the same' since the TIA. He was not hypertensive and his current medications included a statin and aspirin.
He was a long-term smoker of about 10 cigarettes a day. Clinical examination On clinical examination he was well with no motor weakness or sensory deficits. Tone and tendon reflexes were normal. His BP was 130/76mm Hg with a regular pulse of 76bpm. His visual acuity was normal when corrected by his spectacles and his fields…
