PMC10044037_01
Involvement of the left oculomotor nerve (III) (A), with ptosis; full recovery (B).
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We report a case of a 61-year-old man, smoker, with arterial hypertension, who was admitted to our hospital with a 4-month history of constitutional symptoms (16% body weight loss and anorexia) and numbness of the plantar surface of the feet, and since the day before, with diplopia, ptosis and sudden changes in oculomotricity in the left eye (Fig. 2). At 3 months' follow-up, a huge improvement was observed with resolution of the diplopia and oculomotricity changes, and improvement of the numbness (Fig. 2 B).
3D TOF MR angiography revealed a small aneurysm of the left posterior communicating artery (arrow).
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A second study was performed and the MRI angiography revealed a small aneurysm of the left posterior communicating artery (Fig. 3), without compression of the oculomotor nerve pathway (Fig. 4 C).
Brain MRI: coronal (A) and axial (B) T2-weighted images showing thickening and hyperintensity of the left oculomotor nerve. On another heavily T2 weighted axial plane (C), it's possible to identify the aneurism of the left posterior communicating artery (black arrow), without anatomical relation with the oculomotor nerve pathway (yellow arrow). Additionally, it also exhibited avid enhancement on postgadolinium fat-saturated T1 weighted images (D, E).
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Additionally, heavily T2-weighted sequences showed thickening and hyperintensity of the left oculomotor nerve (Fig. 4 A, B), with avid enhancement after gadolinium administration, more conspicuous on fat-saturated T1-weighted images (Fig. 4 D, E).