MSFinals-3209

A 42-year-old man is brought to the Emergency Department (ED) after being involved in a motor vehicle accident, in which he was thrown from a motorcycle. In the ED, the patient is unresponsive. Neurological examination shows intact pupillary and corneal reflexes, but the rest of the examination cannot be completed. Thirty minutes later, computerised tomography (CT) reveals uncal herniation of the right temporal lobe, and the patient is rushed to surgery.
What physical examination finding change is most consistent with this patient’s presentation?