13th February 2025

A 75-year-old male with a history of multiple previous MIs, diabetes, hypertension and a 50-pack-year history of smoking, presents with horizontal binocular double vision which worsens on looking to the right.

A 75-year-old male with a history of multiple previous MIs, diabetes, hypertension and a 50-pack-year history of smoking, presents with horizontal binocular double vision which worsens on looking to the right. He denies any pain or giant cell arteritis symptoms. There is no history of trauma.

Bloods include an HbA1c of 78 mmol/mol and, on presentation, his systolic blood pressure is 165 mmHg.  What is the most likely diagnosis?

Select the SINGLE most appropriate option from the list below. Select ONE option only.