case_images: PMC10035546_01
case_images: Pupillometry test with pilocarpine 0.1%, (a) before and (b) 30 min after instillation. The right pupil miosis is more pronounced compared to the left (OD 0.67 mm, OS 0.2 mm in photopic conditions).
case_images: cop529231_f01.jpg
case_images: PMC10035546_01_cop529231_f01.jpg
case_images: F1
case_images: Suspecting a tonic pupil, we conducted a pilocarpine 0.1% test which demonstrated increased relative pupil miosis on the right eye compared to the left (right pupil photopic/scotopic 6.46 mm/4.4 mm vs. left pupil photopic/scotopic 6.01 mm/3.41 mm before pilocarpine and right pupil photopic/scotopic 4.38 mm/3.77 mm vs. left pupil photopic/scotopic 6.01 mm/3.21 mm after pilocarpine eye drops) (Fig. 1a, b).
case_images: Image fusion of a high-resolution 3D T2-weighted MRI sequence and a time-of-flight angiography sequence, 0.6-mm-thin reformatted slices: axial (a); coronal (b); right sagittal (c). Arteries are displayed in color, cranial nerves and brain structures are displayed in black, and cerebrospinal fluid (CSF) is white. Axial, coronal, and sagittal images depicting the cisternal cranial nerves III (CN III) show close contact between the right posterior cerebral artery (PCA, black dashed arrow) and the right CN III (white arrow) which is indented and displaced infero-laterally. Note for comparison that the contralateral CN III (thin white arrow) is surrounded by CSF and there is no contact between the nerve and the left PCA (thin black arrow in b). MRI findings document neurovascular conflict involving the right PCA and CN III. The short arrow in a and b points at the basilar artery.
case_images: cop529231_f02.jpg
case_images: PMC10035546_01_cop529231_f02.jpg
case_images: F2
case_images: T2-weighted thin slice (0.6 mm), constructive interference steady state gradient echo sequences allowing reconstruction in any given plane, and fusion between the different sequences (Fig. 2).
case_images: MRI angiography (lateral view) shows no intracranial aneurysm and normal vessels. The right and left PCAs are marked (white arrow).
case_images: cop529231_f03.jpg
case_images: PMC10035546_01_cop529231_f03.jpg
case_images: F3
case_images: No intracranial aneurysm or other anomaly was present (Fig. 3).