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Year : 2019  |  Volume : 57  |  Issue : 2  |  Page : 182-183

Posterior communicating artery aneurysm presenting with ipsilateral oculomotor nerve palsy


Department of Radiology, Holy Family Hospital, Thodupuzha, Kerala, India

Date of Web Publication10-Sep-2019

Correspondence Address:
Dr. Reddy Ravikanth
Department of Radiology, Holy Family Hospital, Thodupuzha - 685 605, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjosr.tjosr_22_19

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How to cite this article:
Ravikanth R, Kamalasekar K. Posterior communicating artery aneurysm presenting with ipsilateral oculomotor nerve palsy. TNOA J Ophthalmic Sci Res 2019;57:182-3

How to cite this URL:
Ravikanth R, Kamalasekar K. Posterior communicating artery aneurysm presenting with ipsilateral oculomotor nerve palsy. TNOA J Ophthalmic Sci Res [serial online] 2019 [cited 2019 Nov 17];57:182-3. Available from: http://www.tnoajosr.com/text.asp?2019/57/2/182/266381




  Description Top


A 62-year-old gentleman presented with a repeated history of headaches which resolved spontaneously. He developed right-sided facial pain with gradual-onset right-sided ptosis and diplopia. The facial pain originated behind the right ear, with radiation across the face. Magnetic resonance imaging revealed a 9 mm × 4 mm saccular, posterior-directed posterior communicating artery (PCOM) aneurysm [Figure 1] and [Figure 2]. Right craniotomy followed by clipping of the right PCOM was performed. Following surgery, he had immediate relief of facial pain and significant improvement of oculomotor nerve palsy (ONP).
Figure 1: Axial magnetic resonance angiogram image demonstrating a saccular right posterior communicating artery aneurysm (arrow)

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Figure 2: Axial FIESTA sequence magnetic resonance image demonstrating compression of right oculomotor nerve (arrow) by the right-sided posterior communicating artery aneurysm

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  Discussion Top


Spontaneous unilateral ONP is the most common presentation related to a PCOM aneurysm.[1] Direct compression or pulsations by the enlarging PCOM aneurysm is the most common mechanism of ONP in patients. Prompt treatment of PCOM aneurysm is required, even if patients do not present with subarachnoid hemorrhage from the aneurysmal site. Either clipping or coiling of aneurysms can be adopted as a treatment strategy.[2] Endovascular coiling of the PCOM can provide good results in the course of ONP recovery.[3] Aneurysms located at the junction of the internal carotid and the PCOM and at the junction of the basilar artery and the superior cerebellar artery are known to cause ONP.[4] Complete neurological and ophthalmological examination, with specific focus on cranial nerve deficits, is suggested in patients presenting to the emergency department with facial pain. Potentially life-threatening conditions such as a large PCOM aneurysm can cause neurological deficits and hence should prompt clinicians to strongly consider neuroimaging in patients presenting with facial pain, ptosis, and diplopia. The presence of subarachnoid hemorrhage and aneurysm size have been found to have no effect on ONP recovery.[5] Time of intervention after the onset of symptoms has been found to affect the severity of ONP.[6] Neuronal injury and neural degeneration may result from long-term oculomotor nerve compression, thus affecting postoperative recovery. ONP can be reversible if PCOM aneurysm is detected and treated early.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Vlak MH, Algra A, Brandenburg R, Rinkel GJ. Prevalence of unruptured intracranial aneurysms, with emphasis on sex, age, comorbidity, country, and time period: A systematic review and meta-analysis. Lancet Neurol 2011;10:626-36.  Back to cited text no. 1
    
2.
Yerramneni VK, Chandra PS, Kasliwal MK, Sinha S, Suri A, Gupta A, et al. Recovery of oculomotor nerve palsy following surgical clipping of posterior communicating artery aneurysms. Neurol India 2010;58:103-5.  Back to cited text no. 2
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3.
Kyriakides T, Aziz TZ, Torrens MJ. Postoperative recovery of third nerve palsy due to posterior communicating aneurysms. Br J Neurosurg 1989;3:109-11.  Back to cited text no. 3
    
4.
Harris P, Udvarhelyi GB. Aneurysms arising at the internal carotid-posterior communicating artery junction. J Neurosurg 1957;14:180-91.  Back to cited text no. 4
    
5.
Bederson JB, Connolly ES Jr., Batjer HH, Dacey RG, Dion JE, Diringer MN, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: A statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke 2009;40:994-1025.  Back to cited text no. 5
    
6.
Kazekawa K, Tsutsumi M, Aikawa H, Iko M, Kodama T, Go Y, et al. Internal carotid aneurysms presenting with mass effect symptoms of cranial nerve dysfunction: Efficacy and imitations of endosaccular embolization with GDC. Radiat Med 2003;21:80-5.  Back to cited text no. 6
    


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