Supranuclear ophthalmoplegia with basilar artery aneurysms

Area of Science:

• Neurology
• Neuroimaging
• Vascular Neurology

Background:

• Supranuclear gaze palsies typically indicate deep brainstem damage.
• Basilar artery aneurysms are a potential, though less common, cause of such neurological deficits.

Observation:

• Two patients presented with supranuclear gaze paresis (horizontal in one, vertical in the other) due to large basilar artery aneurysms.
• Computed tomography (CT) and vertebral angiography were used for diagnosis.
• Autopsy confirmed the diagnosis in one patient.

Findings:

• Large basilar artery aneurysms can indirectly cause supranuclear gaze palsies by compressing brainstem structures.
• The extrinsic nature of the lesion leading to intrinsic-like neurological signs was demonstrated.

Implications:

• Basilar artery aneurysm should be included in the differential diagnosis for patients with supranuclear gaze paresis and long tract signs.
• Neuroimaging and angiography are crucial for identifying these vascular lesions.