A 72-year-old woman presented with intermittent diplopia. She had a history of vascular disease, but no history of stroke or psychiatric disturbance. On examination, she developed convergence spasm with associated miosis following fixation on near targets and during horizontal smooth pursuit (video, figure 1). The spasms were terminated with a blink. She had no ptosis, her eye movements were normal in range, and her pupils were equal in size with normal reactions to light. Neurologic examination was otherwise unremarkable. Five years prior to her current presentation, a left-sided terminal carotid artery aneurysm had been incidentally detected. The …
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