Diabetic Drew's Diplopia

Drew, a 56-year-old, right-handed, obese hypertensive man, suddenly began having double vision when he looked to the left with both eyes open, but not when he closed either eye. Aside from his high blood pressure, he had been well previously. On review of systems, however, he indicated that he had been having urinary frequency and nocturia.
 

On examination, he was obese and his blood pressure was 160/75. The remainder of the general physical examination was normal. Neurological examination showed full visual fields and equal and reactive pupils. The eyes were dysconjugate. Movement of the left eye was normal. However, the right eye was partially paralyzed, externally rotated, and depressed. It did not move medially past the mid-line when attempting conjugate gaze to the left, nor could it move upward. The rest of the neurologic examination was normal.

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