An otherwise healthy, 11-year-old boy presented with a long-standing history of right eye esotropia associated with a right head turn. Following a mild blunt facial trauma, he was brought to an ophthalmologist for binocular horizontal diplopia. Cranial CT scan revealed a large, enhancing lesion in the right cavernous sinus. Neuro-ophthalmological evaluation showed abduction deficit of the right eye, right corneal anaesthesia, right upper lid ptosis and a smaller right pupil suggesting involvement of the intracavernous segments of the right abducens nerve, ophthalmic nerve and oculosympathetic fibres. Cerebral angiography confirmed a large aneurysm involving the petrous, lacerum and cavernous segments of the right internal carotid artery. The child underwent successful clipping of the aneurysm by the neurosurgery service.
Keywords: cranial nerves; neuroimaging; neurosurgery; pupil; visual pathway.
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