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PComA Aneurysm – Third Nerve Palsy — SCE Neurology MCQ

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ModerateCerebrovascular DiseasePComA Aneurysm – Third Nerve PalsySCE Neurology

A 45-year-old woman presents with right pupil-involving third nerve palsy (complete ptosis, dilated unreactive pupil, eye down and out) and severe ipsilateral headache. CTA reveals right PComA aneurysm. What is the next step?

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Correct answer: B — Urgent neurosurgical referral for coiling or clipping

A painful pupil-involving third nerve palsy from a PComA aneurysm is a neurosurgical emergency — the aneurysm may rupture at any time. Urgent treatment (coiling or clipping) is required. A: Observation risks fatal rupture. C: Aspirin worsens haemorrhage risk. D: LP is not needed — CTA confirmed the aneurysm. E: Outpatient follow-up is inappropriate.

Reference: RCP National Clinical Guideline for Stroke (2023)