1. A 48-year-old man with ptosis and limitation of elevation in the left eye © 2014 American Academy of Neurology Teaching NeuroImages Neurology Resident and Fellow Section

2. Vignette A 48-year-old man presented with ptosis in the left eye for 2 months. He denied ocular pain, diplopia, visual loss, or diurnal fluctuation. Neurologic examination showed incomplete ptosis and limitation of elevation with normal pupil in the left eye. Park et al. © 2014 American Academy of Neurology

3. Imaging © 2014 American Academy of Neurology Park et al.

4. Divisional patterns of oculomotor nerve palsy usually indicate a lesion involving the oculomotor nerve distal to anterior cavernous sinus where the nerve divides into the superior and inferior branches. In this patient, the ptosis and limitation of elevation in the left eye indicate a lesion limited to the oculomotor superior division that innervates the levator palpebrae and superior rectus. Orbital lesions including lymphoma should be considered in divisional patterns of oculomotor palsy. Superior Divisional Oculomotor Nerve Palsy due to Orbital Lymphoma © 2014 American Academy of Neurology Park et al.