Dupas Bénédicte, Milea Dan, Sourour Nader, LeHoang Phuc
Service d'Ophtalmologie, Hôpital de la Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex 13, France.
Graefes Arch Clin Exp Ophthalmol. 2006 Nov;244(11):1539-41. doi: 10.1007/s00417-005-0240-z. Epub 2006 Mar 15.
Intracranial aneurysms may be a cause of ocular motor dysfunction, the third nerve being more often involved than the two other cranial ocular motor nerves.
We report the unusual occurrence of an isolated fourth nerve palsy related to a cavernous carotid aneurysm, angiographically confirmed. The patient already underwent clipping of a ruptured posterior communicating artery aneurysm 17 years earlier, revealed at that time by a third nerve palsy.
Endovascular treatment of the cavernous carotid aneurysm was performed, resulting in complete recovery of the palsy.
Occurrence of an acquired fourth nerve palsy in a patient with a past history of aneurysm should prompt neurovascular imaging as multiple aneurysms may cause sequential ocular motor palsies.
颅内动脉瘤可能是动眼功能障碍的一个原因，第三神经比其他两条颅部动眼神经更常受累。
我们报告了一例与海绵窦段颈内动脉瘤相关的孤立性第四神经麻痹的罕见病例，血管造影证实。该患者17年前曾因第三神经麻痹发现并接受了破裂的后交通动脉瘤夹闭术。
对海绵窦段颈内动脉瘤进行了血管内治疗，麻痹完全恢复。
有动脉瘤病史的患者出现后天性第四神经麻痹应促使进行神经血管成像检查，因为多个动脉瘤可能导致相继的动眼神经麻痹。
