Posterior Communicating Artery (PCOM) Aneurysm: Difference between revisions
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==Background== | ==Background== | ||
*Acute [[CN III palsy]] with ipsilateral pupil dilation is PCOM aneurysm until proven otherwise | *Acute [[CN III palsy]] with ipsilateral pupil dilation is PCOM aneurysm until proven otherwise | ||
**Aneurysm compresses the outer fibers (pupillomotor) of CN III | **Aneurysm compresses the outer fibers (pupillomotor) of CN III → dilation | ||
**In contrast to CN III palsy due to | **In contrast to CN III palsy due to diabetes mellitus or hypertension in which pupil is spared | ||
==Clinical Features== | ==Clinical Features== | ||
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
===Binocular Diplopia=== | |||
*Basilar Artery Thrombosis | |||
*[[Posterior Communicating Artery (PCOM) Aneurysm|Posterior communicating artery (PCOM) aneurysm]] | |||
*[[vertebral and carotid artery dissection|Vertebral artery dissection]] | |||
*[[Myasthenia Gravis]]<ref>Kusner LL, Puwanant A, Kaminski HJ: Ocular myasthenia: Diagnosis, treatment, and pathogenesis. Neurologist 2006; 12:231-239</ref> | |||
*[[Lambert-Eaton Myasthenic Syndrome |Lambert-Eaton Syndrome]] | |||
*[[Botulism]] | |||
*[[Cavernous sinus thrombosis]] | |||
*[[Intracranial mass]], brainstem mass | |||
*Miller Fischer variant [[Guillain-Barre]]<ref>Bushra JS: Miller Fisher syndrome: An uncommon acute neuropathy. J Emerg Med 2000; 18:427-430</ref> | |||
*[[Multiple Sclerosis (MS)| MS]] | |||
*[[Hyperthyroidism | Hyperthyroid]] Proptosis | |||
*Basilar [[Meningitis]] | |||
*[[Stroke (Main) |CVA]] | |||
*Muscular Entrapment from [[Maxillofacial Trauma |Trauma]] | |||
*[[Third nerve palsy]] | |||
== | ==Evaluation== | ||
== | ==Management== | ||
*Emergent BP reduction if hypertensive | *Emergent [[antihypertensives|BP reduction]] if hypertensive | ||
*Neuroimaging | *Neuroimaging | ||
*Neurosurgical consult | *Neurosurgical consult | ||
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==References== | ==References== | ||
<references/> | |||
[[Category: | [[Category:Neurology]] | ||
[[Category:Vascular]] | |||
Latest revision as of 18:32, 28 September 2019
Background
- Acute CN III palsy with ipsilateral pupil dilation is PCOM aneurysm until proven otherwise
- Aneurysm compresses the outer fibers (pupillomotor) of CN III → dilation
- In contrast to CN III palsy due to diabetes mellitus or hypertension in which pupil is spared
Clinical Features
- Inhibition of ipsilateral medial gaze, upward gaze, downward gaze, ptosis
- Lateral gaze (abduction) is preserved
- Ipsilateral dilated pupil
Differential Diagnosis
Binocular Diplopia
- Basilar Artery Thrombosis
- Posterior communicating artery (PCOM) aneurysm
- Vertebral artery dissection
- Myasthenia Gravis[1]
- Lambert-Eaton Syndrome
- Botulism
- Cavernous sinus thrombosis
- Intracranial mass, brainstem mass
- Miller Fischer variant Guillain-Barre[2]
- MS
- Hyperthyroid Proptosis
- Basilar Meningitis
- CVA
- Muscular Entrapment from Trauma
- Third nerve palsy
Evaluation
Management
- Emergent BP reduction if hypertensive
- Neuroimaging
- Neurosurgical consult