Aneurysm misdiagnosed as 1 case of painful ophthalmoplegia.docVIP

 PAGE \* MERGEFORMAT 5 Aneurysm misdiagnosed as 1 case of painful ophthalmoplegia [Keywords:] Aneurysm, painful ophthalmoplegia 1 case in our hospital aneurysm misdiagnosed as painful ophthalmoplegia in 1 case, now reported below. 1 Case information Patients, female, 65 years old, with sudden pain in his right eye, as the weight of weeks of video 2 h admission. 1 day ago in patients with no obvious incentive to appear on the right eye discomfort, were not seriously, 2 h before the patients in the bend picking Found something sudden severe pain in the right eye, the right eyelid elevation weakness, depending on the material about ghosting, no nausea, vomiting, coma, twitching mouth, no limbs twitch, no numbness, weakness. The patient had previous history of hypertension, headache and no history of head injury. examination: BP 180/100 mm Hg, neurological examination: conscious, verbal fluency, the amount of grain symmetry, a strong bilateral eyes closed, unable to right eyelid elevation the right eye slightly adduction, abduction, from top to bottom, as were limited (Figure 1, bilateral pupil and other large, about 3cm, light reflex sensitivity, fundus normal, limb muscle strength, muscle tone normal, no body checking the depth of feeling abnormalities, the pathological not elicited bilateral meningeal irritation negative. no abnormal blood tests. admission diagnosis of “painful ophthalmoplegia” and give glucocorticoid therapy, no significant improvement in symptoms, and from 2 Sunday morning started right eye is almost fixed, ptosis, eye pain and more obvious. and then given to brain CT, MRI, MRA, DSA examination. Head CT scan prompted multiple bilateral MCA distribution point sheet low-density lesions, cerebral gray and white matter boundaries clear, ditch back to the bilateral symmetry. Brain MRI (Figure 2: T2WI tips right internal carotid artery about 2.5 cm 1.5 cm size of the low signal, T1WI edge of the high signal of cystic material, brain