Abstract
Paresis of the oculomotor nerve is a very rare complication of an unrup tured arteriosclerotic fusiform aneu rysm of the basilar artery. A handful of cases are described in the world literature.
A fifty-four-year-old man with a history of hypertension and diabetes mellitus presented with painless par tial oculomotor palsy of sudden onset. A cerebral angiogram demonstrated a tortuous fusiform deformity of the basilar artery and the origin of the posterior cerebral arteries, indica tive of all arteriosclerotic aneurysmal dilation.
A sudden onset of a pupil-sparing ophthalmoplegia is the typical history of a microvascular infarct of the third nerve, whereas pupillary sparing in aneurysmal oculomotor paresis is a very rare event. Special emphasis has been placed on the pupillary size as a guide for the indication of arteriog raphy. The many exceptions to this ruie suggest that cerebral arteriog raphy may be indicated more often than generally believed.
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