Neurointervention.  2023 Nov;18(3):195-199. 10.5469/neuroint.2023.00283.

Unilateral Oculomotor Nerve Palsy as a Rare Manifestation of Isolated Pre-Communicating Segment of Posterior Cerebral Artery Thrombosis

• Seraj FQM
• Najafi S
• Pahlavan H
• Organji H
• Baharvahdat H

• KMID: 2547282
• DOI: http://doi.org/10.5469/neuroint.2023.00283

Abstract

Ipsilateral mydriasis (IM) is usually not acute. However, the acute occurrence of unilateral dilated pupil may result in acute ischemic stroke. Herein, we present 3 patients with IM, lateral eye deviation, ptosis, and contralateral hemiparesis due to isolated occlusion of the pre-communicating segment of the posterior cerebral artery with preservation of the posterior communicating artery, which was successfully treated by emergent mechanical thrombectomy. In a 3-month follow-up, all patients were independent without any neurological deficits.

Keyword

Aspiration thrombectomy; Ischemic stroke; Oculomotor nerve palsy; Posterior cerebral artery infarction

Figure

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  Fig. 1. Patient 1. (A) Cerebral angiogram shows left isolated pre-communicating (P1) occlusion (black arrowhead). (B) Ipsilateral internal carotid artery injection shows post-communicating posterior cerebral artery (PCA) filling by the left posterior communicating artery. (C) Post-thrombectomy angiogram shows patent P1 and PCA.

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  Fig. 2. Patient 2. (A) Post-operative angiography reveals isolated left pre-communicating (P1) occlusion in vertebral injection (black arrowhead). (B) Ipsilateral internal carotid artery injection shows post-communicating posterior cerebral artery (PCA) filling by left posterior communicating artery. (C) Post-thrombectomy angiogram shows patent P1 and PCA in vertebral injection.

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  Fig. 3. Patient 3. (A) Initial vertebral injection angiogram shows right pre-communicating segment occlusion (black arrowhead). (B) Right carotidal injection shows the right posterior communicating (PCOM) artery. (C) Right vertebral injection also demonstrates patent basilar artery and PCOM artery.

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  Fig. 4. The illustration shows the pre-communicating (P1) segment of posterior cerebral artery branches (thalamoperforating arteries) supplying the oculomotor nerve. The occlusion of the P1 could affect the arterial supply of the oculomotor nerve in acute ischemic stroke. 1, P1 segment; 2, P2 anterior segment; 3, superior cerebellar artery; 4, cerebellar peduncle; 5, oculomotor nerve; 6, thalamoperforating arteries; 7, mesencephalon; 8, basilar artery; 9, a clot in the P1 segment.

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