A 59-year-old black female presents to the Emergency Department with a 3-day history of left sided headache and blurry vision. She has a history of thyroid eye disease and hypertension and she smokes 1 pack of cigarettes a day. Her exam seemed normal to the treating physician and she was discharged home. The next day she awoke with complete ptosis of the left upper eyelid. You have to hold her eyelid open with your finger to examine her motility, seen here:

12 comments

  1. Restrictive myopathy in thyroid eye disease rule out associated myasthenia gravis, rule out orbital apex compression cn3 palsy.

  2. Initially, i thought, complications related with the primary disease(TED). But with critical thinking found to be complete third nerve palsy. so what i learnt from the case scenario is; things are not strait forward and thinking out of the box

  3. I think that She has III par palsy and trouble in vision.
    Then I would ask for Brain and Orbits MRI+ MRA and MRV.
    I would look for aneurism of the left posterior communicante artery in the brain and some pathology in the orbitary apice.

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