A 38-year-old woman presented with headache and left periorbital pain of one week duration and diplopia in the last 24 hours.
Motor examination revealed paresis of the superior and internal rectus muscles and moderate ptosis in the left eye.
There were no other ocular or neurological findings.
Cranial magnetic resonance imaging (MRI) was normal.
A Tolosa-Hunt syndrome was diagnosed and corticosteroid treatment was initiated.
Two days later, pain relief persisted and the patient began to report a decrease in near visual acuity.
Left mydriasis was observed on examination.
An orbital MRI was performed, which showed a partially thrombosed internal carotid-posterior communicating (IC-CP) aneurysm at T2.
Computed tomography angiography (CAT-angio) showed a multilobulated left CI-CP aneurysm of 10x5 mm. Brain angiography and embolization were performed, and the aneurysm was completely filled up Vicrony®
Puptosis and adduction improved completely two weeks after embolization.
Eight months after treatment a slight elevation deficit persisted without the patient reporting diplopia.
