Delayed onset diplopia following head trauma.

A 78-year-old woman presented with proptosis and double vision for 2 weeks. One month prior, she had fallen and suffered a skull fracture with a nonsurgical epidural hematoma. Visual acuity was 20/20 bilaterally. Her right pupil was 2 mm and reactive, and her left pupil was 4 mm and fixed. She had ptosis, inability to adduct, and limited elevation of the left eye (Figure 1). A bruit was auscultated over the left eye. The remainder of her neurological examination was normal. A computed tomography (CT) angiogram of the brain was obtained (Figure 2).