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JAMA Neurology Clinical Challenge
October 2018

Subacute Progressive Ptosis, Ophthalmoplegia, Gait Instability, and Cognitive Changes

Author Affiliations
  • 1Department of Neurology, New York University School of Medicine, New York
JAMA Neurol. 2018;75(10):1284-1285. doi:10.1001/jamaneurol.2018.1588

A 70-year-old woman with long-term tobacco use presented with 2 weeks of bilateral ptosis and binocular horizontal diplopia. She denied weakness, difficulty swallowing, or breathing. On initial examination, she had a normal mental status, no pupillary abnormalities, normal visual acuity, and full visual fields. She had moderate exotropia, severe bilateral ptosis, impaired bilateral adduction and vertical ductions, and impaired convergence. Her abduction and vertical oculocephalic reflexes were intact. She had full strength and normal sensation and reflexes but had a slightly wide-based and unsteady gait. Over the subsequent weeks, she experienced worsening gait, falls, inattention, and short-term memory loss.

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