When a bruise is not just a bruise

A 58-year-old woman developed binocular diplopia after violently retching during an episode of gastroenteritis. She experienced discomfort over the left lower eyelid and then developed diplopia, maximal on left gaze. On examination, there was restriction of left eye abduction. Visual acuity was normal. Her pupils were equal and reactive. She had no ptosis or proptosis, and fundoscopy was normal. An unenhanced CT scan of head was reported as normal and she was discharged home with a diagnosis of an idiopathic left sixth cranial nerve palsy. Two …