J Korean Neurosurg Soc.  2014 Jul;56(1):48-50. 10.3340/jkns.2014.56.1.48.

Asymptomatic Penetration of the Oculomotor Nerve by a De Novo Aneurysm Associated with Severe Atherosclerotic Stenosis of the Supraclinoid Internal Carotid Artery

• Shin HS
• Lee SH
• Koh JS

• KMID: 2067076
• DOI: http://doi.org/10.3340/jkns.2014.56.1.48

Abstract

A 70-year-old woman presented with headaches and recurrent stroke symptoms. During five years, the patient has been treated for cerebral infarction associated with severe atherosclerotic stenosis of the internal carotid artery. Three-year follow-up magnetic resonance angiography showed a tiny de novo aneurysm arising from the distal part of atherosclerotic internal carotid artery. And 5-year follow-up three-dimensional CT angiogram demonstrated a definite aneurysm enlargement as large as requiring treatment. During dissection of aneurysm, the oculomotor nerve was found to be penetrated with the growing de novo aneurysm. The authors report a case of a de novo aneurysm, which resulted from atherosclerotic stenosis of the internal carotid artery at the supraclinoid portion, that was found to be penetrating the oculomotor nerve with no ocular palsy.

Keyword

Aneurysm; Atherosclerosis; De novo; Oculomotor nerve; Penetration

MeSH Terms

Aged
Aneurysm*
Atherosclerosis
Carotid Artery, Internal*
Cerebral Infarction
Constriction, Pathologic*
Female
Follow-Up Studies
Headache
Humans
Magnetic Resonance Angiography
Oculomotor Nerve*
Paralysis
Stroke

Figure

• 

  Fig. 1 Brain magnetic resonance (MR) angiogram (A) in 2006 showing a severe atherosclerotic stenosis of the internal carotid artery (ICA) at the supraclinoid portion (arrow). Three-year follow-up MR angiogram (B) in 2009 revealing a tiny de novo aneurysm (open arrowhead) in the distal part of the ICA. Subtracted lateral view (C) angiogram in 2011 demonstrating a wide necked, elongated shape aneurysm (open arrowhead) in the communicating segment of atherosclerotic ICA. Intraoperative photographs during clip placement (D) and illustration (E) showing the aneurysm, which is proximal to the anterior choroidal artery, projecting posterolaterally and penetrating into the oculomotor nerve. III : oculomotor nerve, asterisk : aneurysm.

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