Sudden death following the diagnosis of pupillary involvement third nerve palsy

S. Kashii, N. J. Schatz, N. R. Miller, R. M. Burde

Research output: Contribution to journalArticlepeer-review


Ten days prior to presentation, a 56-year-old woman was diagnosed with complete third nerve palsy with a fixed dilated pupil by her ophthalmologist. According to the patient, she noted binocular diplopia and a drooping eyelid on the right side a week before she consulted the local hospital. We confirmed the diagnosis and obtained an immediate CT study with enhancement which revealed an internal carotid aneurysm. The patient was encouraged to consult a neurosurgeon as early as possible, because of the balloon-like nature of the aneurysm, since we could not predict when it might rupture. We gave her a referring letter to our neurosurgeon and suggested that she consult him as early as possible. She was also given a special note for the emergency room of her neighborhood hospital in case she developed any change in her symptoms during the weekend. After she returned home on that night, she lost consciousness during a telephone conversation. She was brought to the ER of her local hospital and a massive subarachnoid hemorrhage was detected. Two weeks later she was pronounced dead. The case is discussed in terms of ophthalmologist's role in the care of patients with aneurysm and the critical importance of immediate referral to an appropriate neuro-surgeon is emphasized. After reviewing the initial CT films, dolichoectasia of the cerebral vessels was indicated and underlying connective tissue disease, such as Ehlers-Danlos type IV was suggested. These findings might explain the unusually rapid course in this patient. Whenever a patient is diagnosed with complete third nerve palsy with pupillary involvement, immediate referral of the patient to a neurosurgeon without delay is warranted.

Original languageEnglish (US)
Pages (from-to)447-455
Number of pages9
JournalNeuro-Ophthalmology Japan
Issue number4
StatePublished - Dec 1 1994
Externally publishedYes


  • cerebral aneurysm
  • dolichoectasia of the internal carotid aneurysm
  • oculomotor nerve palsy
  • pupillary involving third nerve palsy
  • subarachnoid hemorrhage

ASJC Scopus subject areas

  • Ophthalmology
  • Clinical Neurology


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