First a third, then a fourth nerve palsy in multiple intracranial aneurysms.
BACKGROUND
Intracranial aneurysms may be a cause of ocular motor dysfunction, the third nerve being more often involved than the two other cranial ocular motor nerves.


METHODS
We report the unusual occurrence of an isolated fourth nerve palsy related to a cavernous carotid aneurysm, angiographically confirmed. The patient already underwent clipping of a ruptured posterior communicating artery aneurysm 17 years earlier, revealed at that time by a third nerve palsy.


RESULTS
Endovascular treatment of the cavernous carotid aneurysm was performed, resulting in complete recovery of the palsy.


CONCLUSIONS
Occurrence of an acquired fourth nerve palsy in a patient with a past history of aneurysm should prompt neurovascular imaging as multiple aneurysms may cause sequential ocular motor palsies.
Service d'Ophtalmologie, Hôpital de la Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex 13, France. dupasbene@hotmail.com
Bénédicte
B
Dupas
Dan
D
Milea
Nader
N
Sourour
Phuc
P
LeHoang
D017542:Aneurysm, Ruptured / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D002340:Carotid Artery Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D002343:Carotid Artery, Internal; D002426:Cavernous Sinus / Q000473:pathology*; D002533:Cerebral Angiography; D004172:Diplopia / Q000175:diagnosis / Q000209:etiology; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D008875:Middle Aged; D015840:Oculomotor Nerve Diseases / Q000175:diagnosis / Q000209:etiology*; D009886:Ophthalmoplegia / Q000175:diagnosis / Q000209:etiology; D020432:Trochlear Nerve Diseases / Q000175:diagnosis / Q000209:etiology*