A 68-year-old diabetic lady with a history of hypertension, remotely treated breast cancer and sarcoidosis (pulmonary, cutaneous and hepatic) presented with four days of rapidly progressive right frontal and periorbital headache, associated with right ptosis, diplopia, and unsteady gait. Negative symptoms for dysarthria, dysphonia, weakness and numbness. Current Medications : Prednisone 20 mg daily for treatment of sarcoidosis, Metformin 850 mg bid, Pioglitazone 45 mg daily, Metoprolol succinate 100 mg daily, Hydrochlorothiazide 25 mg daily, ASA 81 mg daily, Pravastatin 20 mg daily. Physical examination: VSS Right ptosis, incomplete elevation, adduction, abduction, anisocoria with right mydriasis with minimal pupillary response to light were present.
Her right nasolabial fold was mildly depressed. The remainder of the neurological exam was normal. Laboratory results: ACE level 19 U/L…
