Pupil‐sparing oculomotor palsies with internal carotid—posterior communicating artery aneurysms

Abstract

The charts of 84 patients admitted to the Neurosurgery Service of the Washington University Medical Center between January, 1960, and July, 1981, with aneurysms at or near the junction of the internal carotid and posterior communicating arteries (ICA-PoCA) were reviewed. Special emphasis was placed on the pupillary size and reactivity of 51 patients with oculomotor nerve involvement. Seven initially had normal pupils, representing 8% of the total group and 14% of those presenting with oculomotor palsies. In 4 of these patients pupillary involvement developed within 5 days, and in 1 pupillary involvement developed in 4 months. Pupillary sparing appears to be more common than previously appreciated in patients with ICA-PoCA aneurysms and oculomotor nerve involvement. Patients with acute somatic oculomotor paresis should be observed closely for at least one week for the development of pupillary involvement. Arteriography may be indicated more frequently than previously recommended.

One-Sided Headache Is a Symptom Suggesting Aneurysmal Lesion in Patients with Isolated Abducens Nerve Palsy

“…9,10 In cases of oculomotor palsy especially in cases with pupillary involvement, an immediate examination with neuroimaging is necessary to rule out the possibility that the palsy was caused by an aneurysm. 11 However, an aneurysm is a rare cause of abducens nerve palsy, with incidences of 3-4%, 12,13 and reports of cases with isolated unilateral abducens nerve palsy due to an aneurysm are still scarcer. 4,5 Our case had had recurrent diplopia episodes before her initial visit to our hospital.…”

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

“…[4][5][6][7]10,13) Orbital pain or headache sometimes proceed to oculomotor nerve palsy which frequently involves the pupil. The external ocular movement is partly disturbed or the eye position becomes exotropic resulting in double vision.…”

Unilateral Oculomotor Nerve Paresis Associated With Anterior Communicating Artery Aneurysm Rupture-Two Case Reports-

“…Both patients showed a pattern of pupil-sparing oculomotor nerve paresis during the early recovery stage, which is not common with ICA aneurysms or traumatic damage. 7,8,14,16) Pupil-sparing is most likely to result from extraaxial microvascular ischemia, which mainly occurs in diabetic patients, because pupillary fibers are located peripherally in the oculomotor nerve. 1) However, our patients had no history of diabetes and did not report eye pain which often accompanies oculomotor nerve ischemia.…”