Paroxysmal Oculosympathetic Paresis and Spasm with Segmental Myoclonus

A 28-year-old woman presented with a four year history of a repetitive 'Jerk' in her left hand. It started immediately after delivery of her last child, occurred every two seconds, continued during sleep, and had persisted since then without stopping. A year later she began to have episodes of sudden flushing of the left side of her face. The left pupil would become smaller and then larger than the right. The episodes lasted 2 to 3 minutes. Their frequency had Increased from bimonthly to twice daily. Triggering factors included exercise and drinking beer or wine.