Unilateral paralysis of eye muscles associated with intracranial saccular aneurysms.

Unexplained unilateral paralysis of eye muscles with or without evidence of altered function of other cranial nerves, or of the presence of intracranial bruit, is strong positive diagnostic evidence of saccular aneurysm of the intracranial internal carotid or of the circle of Willis. If pulsating exophthalmos is present the lesion probably is an arteriovenous fistula. The presence of such clinical signs strongly indicates the desirability of cerebral angiography. Once demonstrated, the lesion can usually be treated successfully by ligation of the contributing vascular connections.