Third nerve palsy due to influenza A infection

Abstract

A previously healthy 38-year-old woman presented with new onset left ptosis and diplopia. Two days prior, she developed nasal congestion, cough, fever, and myalgias. Examination revealed left ptosis and a limitation of elevation, depression, and adduction of the left eye (50% of normal). Pupils were equal sizes and reactive to light, and the remainder of the neurological examination was normal. Magnetic resonance imaging with gadolinium revealed mild enhancement (Fig. 1A) and an increased size and T2 signal (Fig.