Table 2.

Neurological team assessment and findings

Assessment	PEARL
Complex ophthalmoplegia	Left eye—failure of adduction, elevation and restricted depression Right eye—failure of adduction, restricted elevation and depression Mild ptosis left eye >right eye not defatigable
Visual field	Full to confrontation
Face	No facial weakness Tingling right side both lips and upper gum. Normal pin prick Tongue and neck strong
Tone	Normal tone in all limbs
Power	Normal power in all limbs
Reflexes	Biceps—absent Triceps—absent Supinator—(R) present with reinforcement Knees—absent Ankles—just present without reinforcement
Plantars	Down
Sensation	Tingling 1–4 finger tips. Normal pin prick
Proprioception	Normal
Vibration	Normal
Finger nose/heel shin	Normal. No ataxia
Gait	Ataxic
Rombergs	Negative