The symptom combination of unilateral frontal headache and oculomotor paralysis has long been recognized by clinicians as characteristic of aneurysm of the intracranial portion of the carotid artery. Prior to the introduction of arteriography by Egas Moniz,1 in 1927, confirmation of the diagnosis was limited to the relatively few cases which were explored surgically or came to autopsy. With the increased use of arteriography and the increased frequency of surgical exploration in the past 15 years, faith in the symptom complex has grown to such an extent that it is now often regarded as diagnostic of intracranial carotid aneurysm.
It is aneurysms of the internal carotid artery which cause the syndrome of unilateral frontal headache and oculomotor paralysis. Only occasionally do these symptoms occur with aneurysms elsewhere. Walsh and King2 studied a series of 32 intracranial aneurysms selected for ocular signs. Fifteen of these had aneurysm of the
LINCOFF HA, COGAN DG. Unilateral Headache and Oculomotor Paralysis Not Caused by Aneurysm. AMA Arch Ophthalmol. 1957;57(2):181-189. doi:10.1001/archopht.1957.00930050189004