45 y male. 20 yrs progressive brown discoloration of skin ov | Figure 1

haitman

Family Medicine

45 y male. 20 yrs progressive brown discoloration of skin over left face and upper neck. Left facial paresthesias abdweakness. progressive blindness and deafness left side. Intermittent dysfagia and dysfonia. On exam: Lt tongue atrophy. Uvula deviated to left. External ophthalmoplegia. Redness left eye with visual acuty 0.1. Abscent red reflex. Facial atrophy left. Brown patches on left. Lt defness. DDx ?

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