First a third, then a fourth nerve palsy in multiple intracranial

Graefes Arch. Clin. Exp. Ophthalmol. · Nov 2006

Case Reports

First a third, then a fourth nerve palsy in multiple intracranial aneurysms.

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. ⋯ 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.

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- Bénédicte Dupas, Dan Milea, Nader Sourour, and Phuc LeHoang.
- Service d'Ophtalmologie, Hôpital de la Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex 13, France. dupasbene@hotmail.com
- Graefes Arch. Clin. Exp. Ophthalmol. 2006 Nov 1; 244 (11): 1539-41.
BackgroundIntracranial aneurysms may be a cause of ocular motor dysfunction, the third nerve being more often involved than the two other cranial ocular motor nerves.MethodsWe 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.ResultsEndovascular treatment of the cavernous carotid aneurysm was performed, resulting in complete recovery of the palsy.ConclusionOccurrence 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.

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First a third, then a fourth nerve palsy in multiple intracranial aneurysms.

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