An Unusual Cause of an Unusual Problem of Ocular Motility

A 42 year old white male with no prior history of medical problems awoke with the acute onset of diplopia that was worse en right gaze. He also noted a tendency to fall to the right. There was no headache, neck stiffness, or other neurologic symptoms. On admission to the hospital his general examination was. normal except fer a bleed pressure of 140/90. Visual Acuity was normal. Pupils were anisoccric with the right 3mm and reactive, and the left 4mm. but only minimally reactive.