Incomplete Oculomotor Nerve Palsy Caused by an Unruptured Internal Carotid-Anterior Choroidal Artery Aneurysm-Case Report-

Abstract

A 59-year-old woman visited our institute with the chief complaint of dizziness which persisted whenever she tried to focus on objects. She had not experienced apparent double vision and had no history of intracranial bleeding. Neurological examination revealed no abnormality except for exotropia at the mid-position and at upper gaze. Cerebral angiography revealed that the intracranial portion of the left internal carotid artery ran more horizontally and also identified an unruptured left internal carotid-anterior choroidal artery (IC-AChA) aneurysm of 3.0 mm diameter. The aneurysm at the origin of the AChA was confirmed during surgery. The proximal lateral wall of the aneurysm was in contact with the oculomotor nerve. This contact was released after complete obliteration of the aneurysm. The exotropia resolved 3 months later. Oculomotor nerve palsy usually indicates the presence of internal carotid-posterior communicating artery (IC-PcomA) aneurysm. Since sacrifice of the AChA will result in severe neurological deficits, accurate neuroimaging information is needed prior to the operation. Conventional angiography and/or three-dimensional computed tomography angiography should be performed to ascertain whether the aneurysm is an IC-PcomA or IC-AChA aneurysm, even if some neurosurgeons insist that conventional angiography is not always needed before surgery for an unruptured aneurysm.

Oculomotor Nerve Palsy Caused by Posterior Communicating Artery Aneurysm: Evaluation of Symptoms after Endovascular Treatment

“…In some cases, the presenting symptoms may vary according to the location and direction of the aneurysm in relation to the course of the cranial nerve within the sinus. Additionally, aneurysms leading to oculomotor nerve palsy are located in the top of the basilar artery, in the superior cerebellar artery and in the anterior choroidal artery [8][9][10] . Because isolated third nerve palsy caused by an intracranial aneurysm usually heralds impending rupture of the aneurysm 2 , urgent treatment is required.…”

Pupil sparing incomplete third nerve palsy secondary to a cavernous sinus meningioma: challenges in management

“…Patients with incomplete third nerve palsy often have more subtle presentations that vary dramatically. These variations in clinical presentation can be attributed to the location of the underlying insult, in particular when associated with compressive lesions 20 . For example, a palsy caused by a deficit of the superior division of the third nerve may affect only the superior rectus and the levator muscles in the involved eye, without pupillary involvement, manifesting as a pupil sparing hypotropia with associated ptosis.…”

Neurological Complications and Surgical Outcome in Patients with Anterior Choroidal Segment Aneurysms

“…These aneurysms most often present with SAH with an incidence ranging between 47%-78% (Friedman et al, 2001;Piotin et al, 2004). They can also present with cavernous sinus syndrome and ophthalmoplegia (Jung, Jeon, Kim, Kwun, & Kim, 2006;Kurokawa, Ishizaki, & Inaba, 2005). The treatment related morbidity and mortality has been reported to be in the range of 10%-28% and 6%-33%, respectively (Drake, Vanderlinden, & Amacher, 1968;Flamm, 1996;Friedman et al, 2001;Viale & Pau, 1979;Yasargil et al, 1978).…”

“…There is marked interchangeability in the area of supply of the AChA, posterior cerebral artery, PcoA, and middle cerebral artery. A large AChA is at times associated with a small PCoA (Kurokawa et al, 2005). This could explain inconsistencies in the clinical syndrome associated with AChA occlusion.…”