Author: Charles Hillman / Editor: Sarah Edwards / Codes: NeuC12, NeuC8, SLO1 / Published: 24/04/2025
A man in his thirties presents to the Emergency Department (ED), after visiting his optician due to blurring of vision and drooping of his right upper eyelid. The optician referred him to the ED for a possible stroke.
The patient has had progressive lethargy for two weeks and specifically notes a reduced ability to perform push-ups. He notices that the eyelid droop sometimes improves when he goes from indoors (where it is warm) to outdoors (where it is cold).
The patient doesn’t report any fevers, weight loss or night sweats. He has no past medical history.
Neurological examination has revealed power 4/5 on proximal upper limb movements, intact reflexes and no sensory changes. Examination of his lower limbs is unremarkable.
He is unable to keep his right eye open on upward gaze for more than 45 seconds.
Visual acuity is L 6/7.8, R 6/12.2, and pupils are equal in size. No photophobia or rapid afferent pupillary defect is detected.
His cardiovascular, respiratory and abdominal examinations are unremarkable. His blood tests, including a venous blood gas, are also unremarkable.