Familial intracranial aneurysm presenting as a subtle stable third nerve palsy. Case report.

Abstract

To the Editor. —Complete or partial third nerve palsies may result from compression of the oculomotor nerve by an internal carotid-posterior communicating artery aneurysm. The onset is typically acute with rapid progression to total third nerve involvement. We describe a subtle, stable third nerve paresis that was the presenting sign of a familial intracranial aneurysm and urge awareness that operable internal carotid-posterior communicating artery aneurysms may present as subtle, incomplete third nerve palsies without a rapidly progressive course. Report of a Case. —An 18-year-old girl had a sudden onset of severe occipital headache associated with vomiting. Over the next three days her pain became localized to the left temporal area. She had no photophobia or neck stiffness. On the third day she developed a left upper eyelid ptosis and sought medical attention. Six months previously, the patient's 38-year-old mother had suffered an acute, right, total third nerve palsy. Cerebral arteriography