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Published on: September 25, 2009
Intracavernous Internal Carotid Artery Aneurysm Presenting as Acute Diplopia: A Case Report
Austin Brown1, Heath Jolliff1, Douglas Poe1
1Adena Regional Medical Center, Department of Emergency Medicine, Chillicothe, Ohio.
Introduction:
Diplopia is an uncommon emergency department (ED) complaint representing only 0.1% of visits, but it has a large differential. One cause is a cranial nerve palsy, which may be from a benign or life-threatening process.
Case Report:
A 69-year-old female presented to the ED with two days of diplopia and dizziness. The physical exam revealed a sixth cranial nerve palsy isolated to the left eye. Imaging demonstrated an intracavernous internal carotid artery aneurysm. The patient was treated with embolization by neurointerventional radiology.
Discussion:
The evaluation of diplopia is initially divided into monocular, usually from a lens problem, or binocular, indicating an extraocular process. Microangiopathic disease is the most common cause of sixth nerve palsy; however, more serious etiologies may be present, such as an intracavernous internal carotid artery aneurysm, as in the patient described. Imaging modalities may include computed tomography or magnetic resonance imaging.
Conclusion:
Some causes of sixth nerve palsy are benign, while others will require more urgent attention, such as consideration of an intracavernous internal carotid artery aneurysm.
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