Isolated Third Cranial Nerve Palsy Following Coronary Angiography: A Rare Neuro-Ophthalmologic Complication

Neurological complications following cardiac coronary angiography (CAG), such as ischemic stroke and neuro-ophthalmologic syndromes, are uncommon but significant. This report presents a rare case of isolated third cranial nerve palsy that developed after CAG, highlighting the potential risks associated with the procedure. A 51-year-old male with a history of hypertension and ischemic heart disease underwent CAG for non-ST-segment elevation myocardial infarction. Although the procedure and subsequent cardiac imaging results were normal, the patient developed sudden onset binocular diplopia, ptosis, and restricted eye movements in his left eye following CAG, indicative of left third cranial nerve palsy. Initial computed tomography (CT) and computed tomography angiography (CTA) scans were unremarkable, but a magnetic resonance imaging (MRI) revealed multiple recent lacunar infarcts, including one along the path of the left oculomotor nerve, suggesting an embolic cause. Neuro-ophthalmologic complications post-CAG, though rare, require early detection and intervention, emphasizing the need for preventive measures in at-risk patients.