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Updated: Aug 10, 2026
11:58
Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms
Published on: August 11, 2015
First a third, then a fourth nerve palsy in multiple intracranial aneurysms
Bénédicte Dupas1, Dan Milea, Nader Sourour
1Service d'Ophtalmologie, Hôpital de la Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex 13, France. dupasbene@hotmail.com
Summary
A rare case of isolated fourth nerve palsy caused by a carotid aneurysm highlights the risk of multiple intracranial aneurysms. Prompt neurovascular imaging is crucial for patients with a history of aneurysms presenting with new ocular motor nerve palsies.
Area of Science:
- Neuroscience
- Vascular Neurology
Background:
- Intracranial aneurysms are known to cause cranial nerve palsies, frequently affecting the oculomotor nerve (CN III).
- Ocular motor dysfunction can be an early sign of underlying vascular abnormalities.
Observation:
- This report details an unusual case of isolated fourth nerve palsy (CN IV palsy).
- The palsy was attributed to a cavernous carotid aneurysm, confirmed via angiography.
- The patient had a prior history of a ruptured posterior communicating artery aneurysm treated 17 years earlier.
Findings:
- Endovascular treatment successfully addressed the cavernous carotid aneurysm.
- Complete recovery from the fourth nerve palsy was achieved post-intervention.
- This case underscores the potential for sequential cranial nerve palsies from multiple aneurysms.
Implications:
- Acquired fourth nerve palsy in patients with a history of aneurysms warrants urgent neurovascular imaging.
- Early diagnosis and treatment of intracranial aneurysms can prevent severe neurological deficits.
- Recognizing sequential palsies aids in identifying and managing complex cerebrovascular conditions.
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