J Korean Soc Emerg Med.  2019 Apr;30(2):198-204. 10.0000/jksem.2019.30.2.198.

Oculomotor nerve palsy associated with internal carotid artery: case reports

• Kim HI
• Choi HJ

• KMID: 2447773
• DOI: http://doi.org/10.0000/jksem.2019.30.2.198

Abstract

Oculomotor nerve palsy limits the specific direction eyeball movement, and represents diplopia, mydriasis, and ptosis. The vascular-associated etiologies of oculomotor nerve palsy are the microvascular ischemia due to hypertension or diabetes, or compression of the nerve by the aneurysm. For the aneurysm, if not treated properly, it may result in mortality or severe neurological impairment. Thorough history taking, physical examinations, and proper imaging modality are needed to make an accurate diagnosis. A 76-year-old female with decreased mentality and anisocoria presented at our emergency department. An 83-year-old female presented with right ptosis and lateral-side deviated of the right eyeball. No definite lesion was noted on the initial non-contrast brain computed tomography (CT) and magnetic resonance imaging diffusion. An aneurysm was detected on CT angiography taken several hours later in the former patient. For the latter patient, a giant aneurysm was detected on magnetic resonance angiography that had been performed at another hospital 4 days earlier. These two patients underwent transfemoral cerebral angiography with coiling. They were discharged with no neurological sequelae.

Keyword

Oculomotor nerve diseases; Aneurysm; Internal carotid artery

MeSH Terms

Aged
Aged, 80 and over
Aneurysm
Angiography
Anisocoria
Brain
Carotid Artery, Internal*
Cerebral Angiography
Diagnosis
Diffusion
Diplopia
Emergency Service, Hospital
Female
Humans
Hypertension
Ischemia
Magnetic Resonance Angiography
Magnetic Resonance Imaging
Mortality
Mydriasis
Oculomotor Nerve Diseases*
Oculomotor Nerve*
Physical Examination