Intercavernous Carotid Artery Aneurysm

Abstract

A 76-year-old woman presented to the Emergency Department (ED) with a 1-week history of inability to move her left eye and lid lag. Her symptoms were initially mild but had been progressively worsening over the preceding several days. After a discussion with her primary care provider, she was prompted to go to the ED for further evaluation. She reported no headache, nausea, or vomiting, and denied having similar symptoms in the past. On physical examination, the patient was afebrile and had normal vital signs. She had a midline left pupil with ptosis and complete loss of extraocular movements. Her pupils were 4 mm bilaterally, the left was sluggishly reactive, and her visual acuity out of the affected eye was grossly normal. Her right eye appeared to be unaffected. She had no other cranial nerve deficits and was otherwise neurologically intact. A noncontrast head computed tomography scan demonstrated a peripherally calcified mass in the left cavernous sinus (Figure 1). Contrast-enhanced magnetic resonance angiography was then performed, showing a 10 15 18-mm aneurysm of the intercavernous portion of the left internal carotid artery (Figure 2.) The patient was subsequently admitted to the Medicine service, and a consult was placed to Neurointerventional Surgery.