The symptoms are very concerning for a third nerve palsy with ptosis and mydriasis. Any oculomotor abnormality? Patient needs vessel imaging (i.e. MRA or CTA) to rule out compressive etiology such as PiCOM aneurysm if he has a third nerve palsy with pupil involvement. Other causes of third nerve palsy (i.e. microvascular in setting of diabetes, etc...) should be investigated if he does have a third nerve palsy.
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