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A 78 year old women was admitted to hospital with collapse and sudden onset left sided hemiplegia and a right sided ptosis. On admission she was drowsy. She had a left hemiplegia and right ptosis. When the right upper eyelid was passively raised, there was a fixed outward deviation of the right eye. Both pupils were of equal size and reacting to light. No diplopia or sensory signs were noted at presentation.
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