Abstract
A 42-year-old female had an episode of headache with elevated blood pressures to 197 mmHg about 1.5 month ago. She underwent an EEG evaluation at a local hospital which came back normal. Diplopia occurred 5 days ago. The patient’s visual acuity was 6/6.7 in the right eye and 6/8.6 in the left. There was left ptosis and 25 prism diopters of exotropia in the left eye. Extraocular movements revealed moderate limitation of adduction, supraduction, and infraduction of the left eye (Fig. 31.1). Slit lamp examination showed a normal anterior segment OU, except for a mid-dilated pupil in the left eye. Fundoscopic examination and visual field examination were normal. She was admitted under the impression of left oculomotor nerve palsy with pupil involvement. Carotid angiography revealed a lobulated protruding component about 1 cm in size, located at the junction of the left internal carotid artery and posterior communicating artery (Fig. 31.2). The patient underwent a craniotomy and clipping of the aneurysm. She recovered nearly completely 2 months later (Fig. 31.3).
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Woodruff MM, Edlow JA. Evaluation of third nerve palsy in the emergency department. J Emerg Med. 2008;35(3):239–46.
Sunderland S, Hughes ES. The pupillo-constrictor pathway and the nerves to the ocular muscles in man. Brain. 1946;69(4):301–9.
Feely M, Kapoor S. Third nerve palsy due to posterior communicating artery aneurysm: the importance of early surgery. J Neurol Neurosurg Psychiatry. 1987;50(8):1051–2.
Motoyama Y, Nonaka J, Hironaka Y, Park YS, Nakase H. Pupil-sparing oculomotor nerve palsy caused by upward compression of a large posterior communicating artery aneurysm. Case report. Neurol Med Chir (Tokyo). 2012;52(4):202–5.
Jacobson DM. Pupil involvement in patients with diabetes-associated oculomotor nerve palsy. Arch Ophthalmol. 1998;116(6):723–7.
Goldstein JE, Cogan DG. Diabetic ophthalmoplegia with special reference to the pupil. Arch Ophthalmol. 1960;64:592–600.
Lv X, Jiang C, Li Y, Yang X, Wu Z. Isolated oculomotor nerve palsy in interventional neuroradiology. Eur J Radiol. 2010;74(3):441–4.
Golshani K, Ferrell A, Zomorodi A, Smith TP, Britz GW. A review of the management of posterior communicating artery aneurysms in the modern era. Surg Neurol Int. 2010;1:88.
Acierno MD, Trobe JD, Cornblath WT, Gebarski SS. Painful oculomotor palsy caused by posterior-draining dural carotid cavernous fistulas. Arch Ophthalmol. 1995;113(8):1045–9.
Carlow TJ. Paresis of cranial nerves III, IV, and VI: clinical manifestation and differential diagnosis. Bull Soc Belge Ophtalmol. 1989;237:285–301.
Molyneux AJ, Kerr RS, Birks J, et al. Risk of recurrent subarachnoid haemorrhage, death, or dependence and standardised mortality ratios after clipping or coiling of an intracranial aneurysm in the International Subarachnoid Aneurysm Trial (ISAT): long-term follow-up. Lancet Neurol. 2009;8(5):427–33.
Tan H, Huang G, Zhang T, Liu J, Li Z, Wang Z. A retrospective comparison of the influence of surgical clipping and endovascular embolization on recovery of oculomotor nerve palsy in patients with posterior communicating artery aneurysms. Neurosurgery. 2015;76(6):687–94.
Arrico L, Giannotti R, Ganino C, Lenzi T, Malagola R. Intracranial aneurysm and diplopia due to oculomotor nerve palsy: pre- and post-operative study. Clin Ter. 2014;165(4):e258–62.
Yanaka K, Matsumaru Y, Mashiko R, Hyodo A, Sugimoto K, Nose T. Small unruptured cerebral aneurysms presenting with oculomotor nerve palsy. Neurosurgery. 2003;52(3):553–7.
Author information
Authors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer Nature Singapore Pte Ltd.
About this chapter
Cite this chapter
Wang, AG. (2018). Pcom Aneurysm with Oculomotor Nerve Palsy (ONP). In: Emergency Neuro-ophthalmology . Springer, Singapore. https://doi.org/10.1007/978-981-10-7668-8_31
Download citation
DOI: https://doi.org/10.1007/978-981-10-7668-8_31
Published:
Publisher Name: Springer, Singapore
Print ISBN: 978-981-10-7667-1
Online ISBN: 978-981-10-7668-8
eBook Packages: MedicineMedicine (R0)