A Rare Case of Internal Carotid Artery Aneurysm Presenting as Total Ophthalmoplegia

Cerebral aneurysms are pathological focal dilatations of cerebral vasculature that are prone to rupture1. Pathogenesis involves aberrations of cerebral vasculature resulting in compromised integrity of internal elastic lamina with associated defects in adjacent media and adventia.1 Apart from posterior communicating artery aneurysm, internal carotid artery aneurysms account for 4 % of all cerebral aneurysms.2 Paraclinoid aneurysms are defined as those originating from the ICA between the infra clinoid portion (C3) and proximal of the posterior communicating artery. Their classification is given by Al Rodhan3 is as follows: Type Ia – superior hypophyseal, type Ib – ventral paraclinoid, type II – true ophthalmic, type III – carotid cave, type IV – transitional, type V – intra cavernous. In literature many cases of cerebral aneurysms presenting with visual symptoms have been reported 4 in which, aneurysms were located on internal carotid artery near ophthalmic artery called as paraclinoid aneurysms. The unruptured cerebral aneurysms cause mass effect hence producing symptoms of nausea, vomiting and severe headache and later on by compressing surrounding cranial nerves produce ocular symptoms like ophthalmoplegia and ptosis. The aneurysms may rupture and result in intracranial bleed which again by mass effect can produce the above told symptoms. We report a case of unruptured intracranial aneurysm presenting with total ophthalmoplegia with visual deficit as the primary symptom.