Posterior Communicating Artery (PCOM) Aneurysm

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Background

  • Acute CN III palsy w/ ipsilateral pupil dilation is PCOM aneurysm until proven otherwise
    • Aneurysm compresses the outer fibers (pupillomotor) of CN III -> dilation
    • In contrast to CN III palsy due to DM or HTN in which pupil is spared

Clinical Features

  • Inhibition of ipsilateral medial gaze, upward gaze, downward gaze, ptosis
    • Lateral gaze (abduction) is preserved
  • Ipsilateral dilated pupil

Treatment

  • Emergent BP reduction if hypertensive
  • Neuroimaging
  • Neurosurgical consult

Source

Tintinalli

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