Pcom Aneurysm with Oculomotor Nerve Palsy (ONP)
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).
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