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Multidetector computed tomographic angiography in isolated third nerve palsy.

Manu R K Mathew¹, Evelyn Teasdale, Robert M McFadzean

¹Department of Ophthalmology and Visual Sciences, University of Nottingham, Nottingham, United Kingdom.

|February 19, 2008

Summary

Multidetector computed tomographic angiography (CTA) safely and effectively detects intracranial aneurysms causing isolated third nerve palsy (ITNP). This imaging technique eliminates the need for conventional cerebral angiography in diagnosing these specific cases.

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Area of Science:

Neurology
Radiology
Vascular Surgery

Background:

Isolated third nerve palsy (ITNP) can be caused by compressive intracranial aneurysms.
Accurate and timely diagnosis is crucial for effective treatment and patient outcomes.

Purpose of the Study:

To evaluate the efficacy of multidetector computed tomographic angiography (CTA) in detecting clinically significant intracranial aneurysms causing ITNP.
To assess if CTA can replace conventional cerebral angiography (CCA) in this diagnostic context.

Main Methods:

Retrospective cross-sectional study of 137 patients presenting with ITNP.
All patients underwent multidetector CTA.
Clinical follow-up was used to exclude missed aneurysms; CCA was performed for treatment confirmation.

Main Results:

Multidetector CTA detected intracranial aneurysms in 27 patients (19.7%), with the smallest significant aneurysm measuring 5.7 mm.
CCA confirmed the aneurysms in 25 treated patients, with no other lesions identified.
No CTA-detected aneurysms were missed, and 74% of patients without aneurysms recovered spontaneously.

Conclusions:

Multidetector CTA is a safe and effective tool for detecting aneurysms causing acute ITNP.
CTA can replace CCA for the diagnosis and treatment planning of aneurysms presenting as ITNP.