An unruptured internal carotid-posterior communicating artery aneurysm presenting with oculomotor nerve palsy in a patient with autosomal dominant polycystic kidney disease: A case report

Abstract

We present a surgical case of a combination of autosomal dominant polycystic kidney disease (ADPKD) and internal carotid-posterior communicating artery (IC-PC) aneurysm presenting with oculomotor nerve palsy. A 57-year-old man suddenly developed left ptosis and double vision. After 6 days from the onset of symptoms, the patient was referred to our hospital. He had mild headache and partial oculomotor palsy. CT scan revealed no subarachnoid hemorrhage. Magnetic resonance angiography (MRA) revealed a left IC-PC aneurysm. The following day, the aneurysm was clipped under a microscope without a dome puncture. The recovery from the oculomotor palsy started with pupillary function. Improvement was next noted in the levator palpebrae muscle, followed by the medial rectus muscle and then the inferior and upper rectus muscles. The patient was discharged without neurological deficits. The most important factor influencing the prognosis of oculomotor palsy is the interval between the onset of the palsy and the time of surgery. If renal dysfunction is mild, early surgery should be performed. We presented this case with a review of the literature.