Soria E, Camell H, Dang H
VA Medical Center, Buffalo, New York.
Angiology. 1989 Oct;40(10):921-7. doi: 10.1177/000331978904001011.
Paresis of the oculomotor nerve is a very rare complication of an unruptured arteriosclerotic fusiform aneurysm of the basilar artery. A handful of cases are described in the world literature. A fifty-four-year-old man with a history of hypertension and diabetes mellitus presented with painless partial oculomotor palsy of sudden onset. A cerebral angiogram demonstrated a tortuous fusiform deformity of the basilar artery and the origin of the posterior cerebral arteries, indicative of an arteriosclerotic aneurysmal dilation. A sudden onset of a pupil-sparing ophthalmoplegia is the typical history of a microvascular infarct of the third nerve, whereas pupillary sparing in aneurysmal oculomotor paresis is a very rare event. Special emphasis has been placed on the pupillary size as a guide for the indication of arteriography. The many exceptions to this rule suggest that cerebral arteriography may be indicated more often than generally believed.
动眼神经麻痹是基底动脉未破裂的动脉硬化性梭形动脉瘤非常罕见的并发症。世界文献中描述了少数病例。一名有高血压和糖尿病病史的54岁男性，突然出现无痛性部分动眼神经麻痹。脑血管造影显示基底动脉及大脑后动脉起始部呈迂曲梭形畸形，提示动脉硬化性动脉瘤扩张。瞳孔保留的动眼神经麻痹突然发作是第三神经微血管梗死的典型病史，而动脉瘤性动眼神经麻痹中瞳孔保留是非常罕见的情况。特别强调将瞳孔大小作为动脉造影指征的指导。这条规则的许多例外情况表明，脑血管造影的指征可能比一般认为的更为常见。
