A 70 year old diabetic male presented with a three weeks history of left temporal pain radiating to the left eye and left side of the neck without any symptoms relating to the ear or nose. Two days later, the patient developed difficulty in swallowing and speaking with nasal regurgitation of fluids. Clinical examination revealed bilateral palatal weakness (more marked on the left side), bilateral weakness of sternocleidomastoids and bilateral weakness of tongue muscles (more marked on the right side). The gag reflex was diminished. There were no pyramidal or cerebellar signs and there was no neck stiffness.