Korean J Otorhinolaryngol-Head Neck Surg.  2009 Sep;52(9):784-788. 10.3342/kjorl-hns.2009.52.9.784.

The 3rd Cranial Nerve Palsy due to Posterior Communicating Artery Aneurism Mimicking Acute Vestibulopathy (Vestbular Neuritis)

• Yun KS
• Lee CM
• Jung JY
• Suh MW

• KMID: 2277105
• DOI: http://doi.org/10.3342/kjorl-hns.2009.52.9.784

Abstract

We present a 66-year old woman complaining of dizziness and vomiting for the previous three days. Her symptoms were quite similar to vestibular neuritis except for mild headache. Spontaneous nystagmus recording, head shake test, and slow harmonic acceleration results were also similar to vestibular neuritis. But the caloric test was not consistent with the chair test results. During the neurologic examination, ptosis, mydriasis, and the diplopia in the left eye were detected, which was indicative of central organic pathology. Bilateral posterior communicating artery aneurysm that was compressing the left oculomotor nerve was detected by CT angiography. A careful and precise neurologic examination should never be neglected when examining a dizzy patient. It was also noticeable that, acute third nerve palsy may present as intermittent saccades which mimic spontaneous nystagmus in vestibular neuritis.

Keyword

Oculomotor nerve; Aneurysm; Posterior communicating artery aneurysm

MeSH Terms

Acceleration
Aneurysm
Angiography
Arteries
Caloric Tests
Cranial Nerve Diseases
Cranial Nerves
Diplopia
Dizziness
Eye
Female
Head
Headache
Humans
Hydrazines
Intracranial Aneurysm
Mydriasis
Neurologic Examination
Oculomotor Nerve
Oculomotor Nerve Diseases
Saccades
Vestibular Neuronitis
Vomiting
Hydrazines