Oculomotor Nerve Palsy Associated with Duplication of Middle Cerebral Artery, Anterior Communicating Artery Aneurysm, and Parietal Meningioma

ABSTRACT

A 61-year-old male presents with diplopia of acute onset and progressive course. He has a history of previous intracranial haemorrhage that was surgically evacuated 7 years ago and was also associated with diplopia. Examination revealed left complete oculomotor nerve paralysis with a fixed and dilated left pupil. Computed tomography (CT) revealed encephalomalacia, evidence of previous craniotomy, and an incidental left parietal convexity meningioma. CT angiography of the brain revealed a left tortuous duplicate middle cerebral artery with fenestration of its proximal part, an anterior communicating artery aneurysm, and a characteristic capillary blush of the meningioma. Possible mechanisms of oculomotor nerve involvement are discussed.

KEYWORDS:

• Anterior communicating artery aneurysm
• computed tomography angiography
• duplicated middle cerebral artery
• meningioma capillary blush
• middle cerebral artery fenestration
• oculomotor nerve palsy

Acknowledgements

The authors would like to thank Walid Elhalaby MD from the Department of Neurosurgery, Cairo University, for his help in interpreting the CT angiography findings of the patient.

Declaration of interest

The authors declare that there are no conflicts of interest. The authors alone are responsible for the writing and content of the article.

Additional information

Funding

None.