To the Editor.
—I enjoyed reading the report by Lustbader and Miller1 in the May issue of the Archives concerning pupil-sparing third nerve palsy due to an aneurysm. I also enjoyed the editorial by Trobe.2 Dr Trobe made the point that below age 20 years, aneurysms are so rare that we can bypass angiography if there are no signs of subarachnoid hemorrhage and if noninvasive imaging is negative. I agree that aneurysms are very rare under the age of 20 years, but if one suspects an aneurysm, angiography may be the only way to make the diagnosis, which might be lifesaving.A 15-year-old boy presented with a four-day history of complete ptosis of the left upper eyelid. He had been experiencing severe headaches for one week and had had two episodes of vomiting. Visual acuity was 20/20 OD and 20/40 OS. He had a complete left third nerve
Pollard ZF. Aneurysm Causing Third Nerve Palsy in a 15-Year-Old Boy. Arch Ophthalmol. 1988;106(12):1647-1648. doi:10.1001/archopht.1988.01060140819005