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BMC Neurology

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Open Access 01-12-2023 | Intracranial Aneurysm | Case report

Single internal carotid cavernous sinus aneurysm presented as bilateral painful ophthalmoplegia: a case report

Authors: Wanwan Zhang, Yinyin Xie, Jiwei Zhang, Cui Wang, Yajun Lian, Hongbo Liu, Nanchang Xie

Published in: BMC Neurology | Issue 1/2023

Abstract

Background

Intracranial aneurysms are the most common vascular cause of painful ophthalmoplegia. Symptoms include retro-orbital pain, diplopia, ophthalmoplegia, trigeminal neuropathy, or a combination of these. Most single aneurysms cause ipsilateral, painful ophthalmoplegia. Here, we report the first, to our knowledge, case of bilateral painful ophthalmoplegia possibly caused by an aneurysm of the cavernous segment of the left internal carotid artery.

Case presentation

A 62-year-old male patient presented with headache and bilateral ptosis. Laboratory tests revealed hypopituitary function. Computerized tomography angiography showed a large aneurysm in the cavernous sinus segment of the left internal carotid artery. Aneurysm embolization was performed in the Nerve Interventional Department. Four months after surgery, the patient's symptoms returned to normal.

Conclusions

This case suggests that patients with bilateral painful ophthalmoplegia should be screened for aneurysms using computed tomography angiography or magnetic resonance angiography immediately.

Mendonça M, et al. Steroid responsive painful ophthalmoplegia: Tolosa Hunt syndrome, Eales disease, or both? Cephalalgia. 2017;37(2):191–4.CrossRef

van Rooij WJ. Endovascular treatment of cavernous sinus aneurysms. AJNR Am J Neuroradiol. 2012;33(2):323–6.CrossRef

Anton-Vazquez V, Dru R, Rich P, Arias M, Macallan D. Images of the month: Cavernous sinus venous thrombosis secondary to Streptococcus milleri maxillary sinusitis: An unusual cause of diplopia and headache. Clin Med (London, England). 2020;20(6):e271–2.CrossRef

Numao A, Suzuki K, Watanabe Y, Izawa N, Nakamura T, Iwanami H, et al. [A 56-year-old woman with adult-onset ophthalmoplegic migraine presenting with recurrent bilateral abducens nerve palsy]. Rinsho shinkeigaku = Clin Neurol. 2012;52(4):239–44.CrossRef

Takasuna H, Sasaki R, Shiraishi M, Doi M, Wakui D, Ito H, et al. Steroid-resistant Tolosa-Hunt syndrome with a de novo intracavernous aneurysm: A case report. Surg Neurol Int. 2016;7(Suppl 30):S779-s84.CrossRef

Vahdani K, McVeigh K, Harrison R, Williams M, Garrott H. Intracranial hypotension mimicking chronic progressive external ophthalmoplegia. Orbit (Amsterdam, Netherlands). 2018;37(5):371–4.

Qu H, Li Y, Chen M, Sun H, Du S, Cheng Y, et al. Cavernous sinus thrombosis: An insidious and dangerous “do-not-miss” diagnosis. Headache. 2021;61(7):1144–9.CrossRef

Puffer R, Piano M, Lanzino G, Valvassori L, Kallmes D, Quilici L, et al. Treatment of cavernous sinus aneurysms with flow diversion: results in 44 patients. AJNR Am J Neuroradiol. 2014;35(5):948–51.CrossRef

Nam KH, Choi CH, Lee JI, Ko JG, Lee TH, Lee SW. Unruptured Intracranial Aneurysms with Oculomotor Nerve Palsy: Clinical Outcome between Surgical Clipping and Coil Embolization. J Korean Neurosurg Soc. 2010;48(2):109–14.CrossRef

10.

Raza H, Chen H, Chansysouphanthong T, Cui G. The aetiologies of the unilateral oculomotor nerve palsy: a review of the literature. Somatosens Motor Res. 2018;35:229–39.CrossRef

11.

Hyland HH, Barnett HJ. The pathogenesis of cranial nerve palsies associated with intracranial aneurysms. Proc R Soc Med. 1954;47(2):141–6.

12.

Tan L, Sandler V, Todorova-Koteva K, Levine L, Lopes D, Moftakhar R. Recovery of pituitary function following treatment of an unruptured giant cavernous carotid aneurysm using Surpass flow-diverting stents. J Neurointerventional Surg. 2015;7(6):e20.CrossRef

13.

Khalsa SS, Hollon TC, Shastri R, Trobe JD, Gemmete JJ, Pandey AS. Spontaneous subarachnoid hemorrhage due to ruptured cavernous internal carotid artery aneurysm after medical prolactinoma treatment. J Neurointerventional Surg. 2017;9(3):e9.CrossRef

Title: Single internal carotid cavernous sinus aneurysm presented as bilateral painful ophthalmoplegia: a case report
Authors: Wanwan Zhang
Yinyin Xie
Jiwei Zhang
Cui Wang
Yajun Lian
Hongbo Liu
Nanchang Xie
Publication date: 01-12-2023
Publisher: BioMed Central
Keywords: Intracranial Aneurysm
Angiography
Aneurysm
Aneurysm
Ptosis
CT Angiography
Diplopia
Ophthalmoparesis
Headache
Published in: BMC Neurology / Issue 1/2023
Electronic ISSN: 1471-2377
DOI: https://doi.org/10.1186/s12883-023-03066-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Single internal carotid cavernous sinus aneurysm presented as bilateral painful ophthalmoplegia: a case report

Abstract

Background

Case presentation

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Case presentation

Conclusions

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