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A 56-year-old woman presented to the emergency department with sudden onset of left-sided ptosis, perioral paraesthesias and dizziness, without imbalance or vertigo, after getting up from bed. She had hyperlipidaemia and was a smoker. General examination was normal. On neurological examination there was asymmetric bilateral ptosis, more on the left, without pupillary or eye movement abnormalities (figure 1). Other cranial nerves, motor and sensory examination, coordination, posture and gait were unremarkable. The Cogan lid-twitch test and eyelid ice-pack test were normal.
Contributors RL-B: drafted the manuscript, took care of the patient and interpreted brain imaging. YI-B: took care of the patient. AV-G: took care of the patient, interpreted brain imaging, revised the manuscript and approved the final version. CS-S: took care of the patient. JD-G: took care of the patient and interpreted brain imaging.
Competing interests None.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed. This paper was reviewed by Luke Bennetto, Bristol, UK.