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Third nerve palsy due to cerebral artery aneurysm in a child
M G Branley1, K W Wright, M S Borchert
1University of Southern California, Los Angeles.
Insights
Cerebral aneurysms can occur in young children, causing third nerve palsy. Early diagnosis with CT and angiography is crucial, even in pediatric cases, to rule out this condition.
Area of Science:
- Neurology
- Vascular Neurology
- Pediatric Neurology
Background:
- Cerebral aneurysms are typically diagnosed in adults.
- Third nerve palsy (oculomotor nerve palsy) can have various causes.
Observation:
- A seven-year-old girl presented with subacute third nerve palsy.
- Initial symptoms mimicked myasthenia gravis due to temporary improvement in ptosis after edrophonium chloride administration.
Findings:
- Cerebral CT identified a hyperdense mass, confirmed by angiography as a posterior communicating artery aneurysm.
- An additional occult aneurysm of the posterior cerebral artery was discovered during surgery.
Implications:
- Cerebral aneurysms should be considered in pediatric patients presenting with acquired third nerve palsy, especially with pupillary involvement.
- Cerebral CT and angiography are recommended for early diagnosis in such pediatric cases.
- The edrophonium chloride test may yield false-positive results for myasthenia gravis in cases of aneurysm-induced third nerve palsy.
Abstract:
We report a case of cerebral aneurysm in a seven-year-old girl who presented with subacutely progressive third nerve palsy. To our knowledge this is the youngest reported patient with this condition. Confusion with myasthenia gravis occurred because of improvement in the patient's ptosis after intravenous edrophonium chloride. Cerebral CT revealed a hyperdense mass that was characterised on cerebral angiography as an aneurysm of the posterior communicating artery. Another occult aneurysm of the posterior cerebral artery was found at surgery. This case demonstrates that third nerve palsy due to cerebral aneurysm may affect patients at a younger age than has previously been recognised. Therefore we suggest that even young children should have aneurysm excluded by cerebral CT and angiography if they present with acquired third nerve palsy involving the pupil. In addition this case highlights the false-positive results that may occur with the edrophonium chloride test for myasthenia gravis.