J Korean Ophthalmol Soc.  2009 Apr;50(4):624-629. 10.3341/jkos.2009.50.4.624.

Ophthalmic Artery Occlusion With Third Cranial Nerve Paresis Associated With Acute Internal Carotid Artery Occlusion

• Ahn JH
• Lee SG
• Kim HW

• KMID: 2212266
• DOI: http://doi.org/10.3341/jkos.2009.50.4.624

Abstract

PURPOSE: We report a case of ophthalmic artery occlusion with third nerve paresis in the left eye due to acute occlusion of the left ICA.
CASE SUMMARY
A 37-year-old man visited our emergency room with "black out" in the left eye, headache, and nausea. The corrected visual acuity was 20/25 in the right eye, and hand motion in the left eye. In the left eye, a relative afferent papillary defect was noted, with an intraocular pressure of six mmHg. Twenty prisms of exotropia in the primary position was observed, and ocular motor examination revealed limitations of supraduction, infraduction, and adduction in the left eye, suggesting third nerve palsy of the left eye. Fundus examination revealed a pale retina in the macula of the left eye. Brain MRI demonstrated multifocal faint low densities in the left caudate nucleus as well as the frontal and parietal lobes. CT angiography and four-vessel angiography demonstrated complete occlusion in the proximal part of the left internal carotid artery ICA.

Keyword

ICA occlusion; Ophthalmic artery occlusion; Third nerve paresis

MeSH Terms

Adult
Angiography
Brain
Carotid Artery, Internal
Caudate Nucleus
Emergencies
Exotropia
Eye
Hand
Headache
Humans
Intraocular Pressure
Nausea
Oculomotor Nerve
Oculomotor Nerve Diseases
Ophthalmic Artery
Paresis
Parietal Lobe
Retina
Visual Acuity

Figure

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  Figure 1. On the 1st day of hospitalization, ocular motor examination revealed limitation of adduction, supraduction, and infraduction in the left eye, and in the primary position, 20 prism diopters of exotropia was seen.

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  Figure 2. On the 1st day of hospitalization, fundus examination revealed pale retina in the macula of the left eye.

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  Figure 3. Fluorescein angiography. There were choroidal filling delay and prolonged arteriovenous transit time.

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  Figure 4. Brain MRI. There are multifocal faint low densities in the left caudate nucleus, and frontal and parietal lobes.

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  Figure 5. Four-vessel angiography. There was an irregular narrowing in the cavernous portion of the left ICA and the petrous and neck portion of the left ICA was not visualized.

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  Figure 6. CT angiography. There was complete occlusion in the proximal part of the left ICA with intraluminal filling defect.

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  Figure 7. At 5 months after the onset of symptom, ocular movement much improved, only mild limitations of adduction in the left eye was seen.

Reference

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