Keep your eyes open: an unusual case of ptosis

A 68-year-old man was referred following sudden onset ptosis of his right eye associated with diplopia and frontal headache. His medical history included recently diagnosed diet-controlled type II diabetes, hypercholesterolaemia, essential hypertension and benign prostatic hyperplasia. Routine medication prior to admission was aspirin, bendroflumethiazide, atenolol, alfuzosin and simvastatin. On admission, complete right ptosis was seen ( Figure 1 ) and eye movements were impaired in a fashion consistent with peripheral oculomotor palsy with pupillary sparing. Neurological examination revealed absent ankle jerks and symmetrical absence of vibration sense and proprioception below the ankles but the remainder of physical examination was normal

A small left pupil and a headache

Carotid artery dissection is an important cause of stroke in young adults. When focal neurological deficit or classic traumatic history is absent, the diagnosis can be challenging. This lesson reports an interesting case of a patient in whom pupillary dysfunction was the presenting sign of acute dissection of carotid artery