Case Studies
Case 1: A young man with sudden onset headache and complete ptosis
A 24-year-old man presents with a sudden onset headache in the night and on getting up finds that he has developed a complete ptosis on the left. When you examine him you discover that he has a complete ptosis on the left and the eye lies down and out with a fixed dilated pupil.
Your Answer:
Correct answer: Left complete third nerve palsy.
Your Answer:
Correct answer: Compressive lesion of this nerve from an expanding posterior communicating artery aneurysm.
Your Answer:
Correct answer: He needs urgent imaging of his cerebral vessels to see if he has an aneurysm in which case he will need urgent neurosurgery as there is a high chance that it will rupture to give a subarachnoid haemorrhage that could be fatal. Imaging of the relevant vessel could be done using special CT or MRI scanning or traditional angiography.
Digitally subtracted lateral view from a cerebral angiogram. The internal carotid artery (ICA) has been selectively
catheterised and contrast medium injected. The posterior communicating artery aneurysm is seen projecting from the dorsal surface of the intradural ICA (open arrow). The posterior communicating artery itself is not seen.