Abstract
A patient with perimesencephalic subarachnoid haemorrhage (PMSAH) developed a delayed third nerve palsy. Three formal cerebral angiograms, a computed tomography cerebral angiogram and a magnetic resonance angiogram all failed to reveal a vascular abnormality. Further investigations did not show any medical cause for the palsy. This appears to be the first case report of a patient with PMSAH presenting with a painful third nerve palsy.