Oculomotor Nerve Palsy due to Ruptured Multiple Anterior Choroidal Artery Aneurysms

ABSTRACT

We present a case of acute subarachnoid hemorrhage in a 64-year-old male with sudden onset of left ophthalmoplegia. Cerebral angiography demonstrated a 10mm elongated aneurysmal sac which arose from the left internal carotid-anterior choroidal artery junction. The pterional approach was performed as an early surgery for aneurysm clipping. At operative field, the anterior choroidal artery aneurysm which directed posteromedially and compressed the origin of left oculomotor nerve was confirmed. And the blood blister like-aneurysm was also seen at the superolateral portion of the proximal bifurcation of the internal carotid-anterior choroidal artery. A large anterior choroidal artery aneurysm was clipped and the blood blister like-aneurysm was reinforced. No case report has been previously published describing a ruptured anterior choroidal artery aneurysm accomplished with third cranial nerve palsy. We reported a case of multiple aneurysms of anterior choroidal artery that caused ipsilateral oculomotor nerve palsy.