Unknowns in Ocular Motility

The patient is a 7-year-old girl who fell off a horse and sustained a compound supracondylar fracture of the right humerus. The wound was cleaned, the fracture reduced, and the right arm set in a cast. About 8 days later, the patient developed progressive dysphagia, nasal speech, facial weakness, blurred vision, diplopia, and drooping of the eyelids. The patient had severe quadriparesis and respiratory insufficiency, but she had no sensory findings, and her mental status was completely normal