Headache The Journal of Head and Face Pain · 1979 · 13 citations · 0 references
MedicineNeurologyOphthalmologyNeuro-ophthalmologyOcular DiseaseOphthalmic SurgeryCranial Nerve PalsiesCranial NervesNeuro-ophthalmic DiseaseNeuro-ophthalmic DisordersOculomotor Nerve DisordersSympathetic OphthalmiaDifferential Symptom DiagnosisHorner Syndrome Differential DiagnosisOcular Motor Nerve PalsiesOculomotor Nerve Aneurysm CompressionOculomotor Nerve Pupil InvolvementPainful OphthalmoplegiaParasympathetic NeuropathyPeripheral Aneurysm
SYNOPSIS A patient with a previously diagnosed left Horner's syndrome suddenly developed severe pain in the left eye and diplopia. Ipsilateral third cranial nerve palsy was present, but the pupil remained small and minimally reactive. A carotid angiogram showed a large aneurysm of the left internal carotid‐posterior communicating junction. Pain was only relieved after successful clipping of the aneurysm and liberation of the third nerve. The effects of combined sympathetic and parasympathetic denervation of the pupil and the mechanism of their development in regard to the differential diagnosis of painful ophthalmoplegia are discussed.