A73-year-oldright-handedmanwithahistoryofhypertensionandhyperlipidemiapresentedwithan18-monthhistoryofdiplopiaandunsteadygait.Healsonotedoscillatingvisionwhenturninghisheadtotheleft.Thediplopiawashorizontalandwasworselookingatobjectsonhisrightoratadistance.Overayear,hisbalanceworsenedtothepointwhereherequiredawalkerduetorecurrentfalls.Sixmonthspriortopresentation,hedevelopeddysphagia(liquidsmorethanthesolids).Hewasalsonotedtohaveshort-termmemoryproblemsinthelast3months.Onexamination,hehadmoderatecognitiveimpairmentwithaMontrealCognitiveAssessment(MoCA)scoreof20/30withpredominantdeficitsinvisuospatialfunctionsandlanguage.Glabellar,bilateralpalmomental,andsnoutreflexeswerepresent.Theleftpupilwassurgicalandnonreactivetolight,andtherewasmechanicalptosisontheleft.Hehadleftexotropiawithfulleyemovements,bilateralhorizontalgaze-evokednystagmus,andupbeatnystagmusonupgaze.Motorstrengthandtonewerenormal.Hewasdiffuselyhyperreflexicwithbilateralextensorplantarresponses.Detailedsensoryexaminationwasnormal.Dysmetriawaspresentbilaterally,moreprominentontheleft中科白癜疯口碑怎么样治疗白癜风哪个医院好
