Double Vision: Isolated Third Cranial Nerve Palsy After Cardiac Catheterization

Area of Science:

• Neurology
• Ophthalmology
• Cardiology

Background:

• Cardiac catheterization is a common procedure for diagnosing and treating coronary artery disease (CAD).
• Neurological complications, though rare, can significantly impact patient outcomes.
• Third cranial nerve palsy (oculomotor nerve palsy) affects eye movement and eyelid control.

Observation:

• A 72-year-old male with diabetes mellitus and CAD developed isolated left third cranial nerve palsy two hours post-cardiac catheterization.
• Symptoms included new-onset double vision, left eyelid ptosis, sluggish pupillary reflex, and impaired eye adduction.
• Neurological examination and neuroimaging (CT angiogram, MRI brain) were unremarkable.

Findings:

• The case highlights an unusual neuro-ophthalmologic complication following a cardiac procedure.
• Embolic phenomena are a suspected mechanism, potentially causing small vessel ischemia or microinfarction.
• The presentation was consistent with isolated oculomotor nerve dysfunction.

Implications:

• Prompt recognition and neuroimaging are essential for diagnosing post-cardiac catheterization neurological events.
• Management includes antiplatelet therapy (aspirin), statins, and ophthalmologic evaluation for symptomatic management (e.g., prism lenses).
• This case underscores the importance of considering rare but serious complications in patients undergoing cardiovascular interventions.