A 55-year-old male presents with sudden onset of excruciating headache and right CN III palsy (ptosis, mydriasis, eye deviated down and out). He has n...

Question

A 55-year-old male presents with sudden onset of excruciating headache and right CN III palsy (ptosis, mydriasis, eye deviated down and out). He has no trauma history. His GCS is 14. What is the most likely cause and why is this a neurosurgical emergency?

Accepted Answer

Posterior communicating artery aneurysm compressing CN III - this represents an expanding or leaking aneurysm at high risk of catastrophic rupture; urgent neurosurgical referral is needed

Answer

Migraine with CN III involvement

Answer

Myasthenia gravis causing ptosis

Answer

Bell's palsy affecting CN III

Answer

Diabetic CN III palsy - this is benign and self-limiting

uk-dipimc MCQ (SBA): PComA Aneurysm - CN III Palsy

A 55-year-old male presents with sudden onset of excruciating headache and right CN III palsy (ptosis, mydriasis, eye deviated down and out). He has no trauma history. His GCS is 14. What is the most likely cause and why is this a neurosurgical emergency?