Pupil-sparing oculomotor palsy caused by fusiform arteriosclerotic aneurysm of the basilar artery--a case report.
Paresis of the oculomotor nerve is a very rare complication of an unruptured arteriosclerotic fusiform aneurysm of the basilar artery. A handful of cases are described in the world literature. A fifty-four-year-old man with a history of hypertension and diabetes mellitus presented with painless partial oculomotor palsy of sudden onset. A cerebral angiogram demonstrated a tortuous fusiform deformity of the basilar artery and the origin of the posterior cerebral arteries, indicative of an arteriosclerotic aneurysmal dilation. A sudden onset of a pupil-sparing ophthalmoplegia is the typical history of a microvascular infarct of the third nerve, whereas pupillary sparing in aneurysmal oculomotor paresis is a very rare event. Special emphasis has been placed on the pupillary size as a guide for the indication of arteriography. The many exceptions to this rule suggest that cerebral arteriography may be indicated more often than generally believed.
Soria
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VA Medical Center, Buffalo, New York.
Camell
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Dang
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H
D001488:Basilar Artery; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D015840:Oculomotor Nerve Diseases; D014057:Tomography, X-Ray Computed