History A 76-year-old man presented to the emergency department with a 1-month history of worsening binocular diplopia on left horizontal gaze, along with 1 week of progressive dysarthria and dizziness. Additionally, he had a chronic history of right-sided cervicobrachialgia related to degenerative disk disease, which had been improving with oral analgesia. The patient’s past medical history included hypertension, dyslipidemia, insomnia, and hypothyroidism. He also had postpolio syndrome affecting the right lower limb. He reported no fever, chills, cough, shortness of breath, abdominal pain, or chest pain. There was no history of rash, intravenous drug use, immunosuppressive medication use, or documented congenital abnormalities. He reported no recent or recurrent bacterial or viral infections. At clinical examination, the patient appeared tired and had a decreased level of alertness. He was hypertensive (165/91 mm Hg) but had a normal body temperature. Other vital signs were unremarkable. Neurologic assessment revealed left abducens nerve palsy, right lower facial palsy, horizontal nystagmus during right eye adduction, and r
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