A 45-year-old woman developed acute diplopia on looking down or to the right. She had a history of migraine with aura, prior Hodgkin lymphoma treated with thoracic irradiation 26 years earlier, epilepsy, smoking, hypertension, hyperlipidemia, and a left middle cerebral artery territory transient ischemic attack 5 years earlier. She previously had surgery, chemotherapy, and radiotherapy for recurrent breast carcinoma. She was taking 200 mg of carbamazepine slow-release formulation daily, 150 mg of aspirin daily, 10 mg of amlodipine daily, 2.5 mg of bendrofluazide daily, 20 mg of tamoxifen daily, and 50 μg of thyroxine daily.
Walsh RA, Murphy RP, Moore DP, McCabe DJH. Isolated Trochlear Infarction: An Uncommon Cause of Acquired Diplopia. Arch Neurol. 2010;67(7):892–893. doi:10.1001/archneurol.2010.131
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