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Image challenge
Sudden Onset Unilateral Ptosis
  1. Yu-Hsuan Lee1,
  2. Che-Ming Yeh1,
  3. Chien Chieh Hsieh1,2
  1. 1 Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
  2. 2 Department of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei 100, Taiwan
  1. Correspondence to Dr Chien Chieh Hsieh, Emergency, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan; Hsiehchienchieh{at}gmail.com

https://doi.org/10.1136/emermed-2021-212166

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    Clinical introduction

    A 59-year-old woman with poorly controlled hypertension emergently presented for sudden onset right eyelid drooping for 1 day. She complained of diplopia on left gaze and dull right periorbital pain. Intermittent throbbing headache was also noted. Earlier on the day of presentation, she visited another hospital where non-contrast cranial CT read as negative.

    On physical examination, severe right-sided ptosis (8 mm), mydriasis (5 mm) with sluggish reaction to light and a downward, lateral deviation of the right eye (figure 1) were observed. She had intact muscular strength and normoreflexia.

    Figure 1

    Severe right-sided ptosis (8 mm).

    Question

    What is the most likely diagnosis according to figure …

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    Footnotes

    • Contributors CCH conceived the study. YHL and C-MY wrote the article. All authors contributed to editorial changes in the manuscript. All authors read and approved the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.