A 59-year-old male was presented with a 12-day headache, four-day diplopia, and ptosis of the left eye. He mentioned a mild upper respiratory infection one month prior to admission. He denied any ataxia. On initial exam the patient had ptosis of both eyes and complete ophthalmoplegia. He was unable to look up, down, right, or left.
Neurological exam was otherwise unremarkable including symmetrical and intact deep tendon reflexes in all extremities, normal gait, and no cerebellar dysfunction. Just hours later the patient was found to have pinpoint pupils bilaterally, and later in the day he had dilation to 3 mm bilaterally. What's your diagnosis? *This case is from the Docplexus Editorial Team for educative purposes only. Stay connected, the answer will be posted soon!
