Dysarthria and ptosis

A 56-year-old man attended the emergency department with his wife, who reported that his speech had become slurred (he denied this) and that he may be having a stroke. The patient described only occasional swallowing difficulty. He had a 10-year history of progressive hearing loss requiring bilateral hearing aids. When aged 11 years, he had undergone resection and radiotherapy for a posterior fossa astrocytoma. He smoked cigarettes and took a statin for hyperlipidaemia.

On examination, he had dysarthria and bilateral ptosis. CT scan of head showed no acute changes. He was admitted for 3 days under the stroke team, and his symptoms improved. An MR scan of brain 5 days later showed the previous posterior fossa surgery with cerebellar atrophy, chronic small vessel disease but no acute infarction. He was referred to neurology.

In neurology outpatients, we obtained a 10-year history of worsening ptosis and vertical diplopia. In the preceding 12 months, there had been…

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