Diplopia, the other great pretender
case report of incomplete third nerve palsy due cerebral aneurism
DOI:
https://doi.org/10.70313/2718.7446.v17.n03.359Keywords:
intermittent diplopia, intermittent ptosis, posterior communicating artery aneurysm, third nerve palsy, neuroophthalmologyAbstract
Our objective is to present the case of a patient with diplopia and headaches, highlighting the relevance of its evaluation and therapeutic management, in the context of a posterior communicating artery aneurysm (PCoP) with oculomotor nerve palsy and preservation of partial pupillary function.
A 57-year-old woman, hypertensive, came to the neuro-ophthalmology service referring intermittent symptoms of diplopia and ptosis in the right eye, sporadic headaches of great intensity, of 3 months of evolution. In the ophthalmologic control there was no diplopia or restrictions in ocular motility, having palpebral aperture within normal parameters, with no other signs or symptoms. In view of the presumptive diagnosis of myasthenia gravis vs. decompensated phoria, the corresponding complementary tests were requested. Three weeks later, while waiting for the studies, she presented to the emergency department for severe hemicranial headache. Neuroimaging showed a PCoP that compromised the fascicular and subarachnoid tract of the right third nerve, so emergency treatment was performed with neurosurgical equipment, avoiding its rupture and risk of life.
In conclusion, the presence of third nerve palsy without pupillary involvement does not exclude the presence of a PCoP, and when faced with a patient with diplopia, it should be considered that within the differential diagnoses there are diseases that require early multidisciplinary management and treatment to preserve the patient's life, as reported in the present case.
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