Search

Paresis of the oculomotor nerve is a very rare complication of an unrup-tured arteriosclerotic fusiform aneurysm of the basilar artery. A handful of cases are described in the world Literature. A fifty-four-year-old man with a history of hypertension and diabetes mellitus presented with painless partial oculomotor palsy of sudden onset. A cerebral angiogram demonstrated a tortuous fusiform deformity of the basilar artery and the origin of the posterior cerebral arteries, indicative of an arteriosclerotic aneurysmal dilation. A sudden onset of a pupil-sparing ophthalmoplegia is the typical history of a microvascular infarct of the third nerve, whereas pupillary sparing in aneurysmal oculomotor paresis is a very rare event. Special emphasis has been placed on the pupillary size as a guide for the indication of arteriography. The many exceptions to this rue suggest that cerebral arteriography may be indicated more often than generally believed. [ABSTRACT FROM AUTHOR]

Contact thermography using liquid crystals provides a simple, inexpensive method of evaluating carotid disease. It does not duplicate information provided by other noninvasive methods, because, whereas Dopplers give an indication of flow and degree of stenosis in the artery, thermography measures the actual hypoperfusion as demonstrated by diminished temperature in areas of the forehead supplied by branches of the ophthalmic artery. A 74-year-old man presented with bilateral carotid distribution TIAs. Carotid Dopplers and angiography revealed 99% occlusion of both internal carotid arteries. Contact thermography showed diminished temperature in the right supraorbital artery territory. The patient subsequently underwent carotid endarterectomy. Following Induction of anesthesia but prior to carotid clamping, the patient became transiently hypotensive. Intraoperative EEG monitoring showed marked attenuation of the background rhythm on the right with preservation of background on the left. Normal rhythm was quickly restored with pharmacologic restoration of the blood pressure. This case illustrates the usefulness of thermography, which predicted the hemisphere in jeopardy when Dopplers and angiography showed equal bilateral disease. [ABSTRACT FROM AUTHOR]