Presentation
The patient presented with right ophthalmoplegia, and a posterior communicating artery aneurysm was ruled out.
Patient Data
A saccular (8.6 mm maximum diameter) aneurysm in the superoposterior aspect of the clinoid (paraophthalmic) segment of the right internal carotid artery.
The right posterior communicating artery is normal. The left posterior cerebral artery arises from the left posterior communicating artery. The basilar artery gives rise to the right posterior cerebral artery.
Case Discussion
The saccular aneurysm in the superoposterior aspect of the clinoid (paraophthalmic) segment of the right internal carotid artery is adjacent to the posterior communicating artery (PCOM) and presented clinically with a similar sign - ophthalmoplegia.
This presentation is often from direct mechanical compression of the oculomotor nerve by PCOM artery aneurysm. However, depending on the direction of the aneurysmal dilatation from the clinoid segment of the ICA, the oculomotor nerve can be variably compressed.
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