A 65-year-old man is being evaluated for new-onset ptosis. Ear | Surgery collections Videos and quizez 2021

A 65-year-old man is being evaluated for new-onset ptosis. Earlier in the day, the patient underwent right total knee arthroplasty for advanced osteoarthritis with no operative complications. While in the postoperative recovery unit, he had difficulty opening his left eye and developed slurred speech. The patient has never had these symptoms, and his preoperative neurologic examination was unremarkable. He has no prior history of double vision, difficulty swallowing, or limb weakness. Medical history includes ischemic stroke with no residual deficits, type 2 diabetes mellitus, hypertension, and a 20-pack-year smoking history. Temperature is 36.7 C (98.1 F), blood pressure is 150/90 mm Hg, pulse is 92/min, and respirations are 12/min. Neurologic examination reveals bilateral ptosis, left greater than right Pupils are equal in size and reactive to light An ice pack is placed over the closed eyelids for 2 minutes, leading to improvement of the ptosis.