We describe a 34-year-old man with acute, nontraumatic inferior branch oculomotor nerve palsy. Complete ophthalmologic, neurologic, and systemic examinations were otherwise normal. The oculomotor nerve palsy resolved, but the patient subsequently developed bilateral upper extremity numbness and painful dysesthesias in the distribution of the median nerves. These observations suggest that inferior branch oculomotor nerve palsy, although uncommon, may occur as part of a more generalized neurologic disorder, presumed in our patient to be either vasculitic or demyelinating in nature.