Dr. Rajwinder Kaur, Dr. Surabhi Sharma
Intra cranial aneurysms are the most common cause of isolated oculomotor nerve palsy with pupillary
involvement. Aneurysm is suspected, particularly when the patient has a history of sudden severe pain in or around theeye. Oculomotor nerve palsy is a sign of alarm in such cases, as it usually is an initial manifestation of the expansion of this vascular malformation. The rupture of an aneurysm leads to a sudden sub-arachnoid haemorrhage with a high rate of morbidity and mortality. Timely neuro-radiological diagnosis and treatment can prevent this catastrophic outcome. Here,
we report a case of 47 year old male patient who presented with acute onset painful isolated third nerve palsy. He was admitted in the emergency department of our hospital with the chief complaint of severe headache which in his words was “this is the worst headache of my life”. MRI was done which was reported to be normal. Magnetic resonance angiogram was done suspecting aneurysm of posterior communicating artery