Minimal oculomotor nerve paresis secondary to unruptured intracranial aneurysm
J. D. Bartleson, J. C. Trautmann and T. M. Sundt Jr
In 12 patients with minimal oculomotor nerve deficits due to unruptured
intracranial aneurysm, the nerve-related findings were incomplete and at
least one element (ptosis, mydriasis, or extraocular muscle weakness) was
spared in every patient. Although symptomatic, the affected cranial nerve
III functions were only partially lost. Six patients had ptosis and
mydriasis, three had ptosis and diplopia, two had mydriasis and diplopia,
and one had mydriasis alone. Eleven patients had accompanying headaches
that were remarkably variable and difficult to categorize. Cerebral
angiography showed the aneurysms, but computed tomography missed one third
of them. The symptomatic aneurysm arose from the internal carotid artery in
six patients, and from the distal basilar artery in six. Fragments of a
cranial nerve III palsy associated with recent onset and ipsilateral
headache suggest an enlarging internal carotid or distal basilar artery
aneurysm.
