A DIFFICULT CASE

Not a microvascular sixth nerve palsy

H Steele¹, J Aram², T Wilhelm⁶, S J Hickman³ and L Ginsberg^4,5

¹ Senior House Officer in Neurology
² Specialist Registrar in Neurology
³ Specialist Registrar in Neurology
⁴ Consultant Neurologist
⁵ Department of Neurology, Royal Free Hospital, London, UK
⁶ Consultant Neuroradiologist, Department of Radiology, Royal Free Hospital, London, UK

Correspondence to:
Dr L Ginsberg, Department of Neurology, Royal Free Hospital, Pond Street, London NW3 2QG, UK; lionel.ginsberg@royalfree.nhs.uk

The first 150 words of the full text of this article appear below.

A 59-year-old man presented with a three-week history of double vision, worse on looking to the left. He also had non-insulin dependent diabetes mellitus, hypertension and hypercholesterolaemia. For the previous six months he had been experiencing daily left-sided frontal headaches, present on awakening but which resolved during the day; they were not associated with nausea and did not have any meningitic or migrainous features. He had had an acute episode of vertigo four months previously, following which he was investigated at another hospital for a possible transient ischaemic attack. A computerised tomography (CT) head scan at that time had been reported as normal. He had occasionally felt vertiginous since then. He was an ex-smoker and drank alcohol only occasionally. Originally from the Philippines, he had lived in the UK for the last 26 years.

On examination his visual acuity was 6/6 in each eye with normal colour vision, visual fields, . . . [Full text of this article]

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