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To the Editor.—
Dr. Scotti's report, "Internal Carotid Origin of a Tortuous Posterior Cerebral Artery: A Cause of Ophthalmoplegia" (Arch Neurol 31:273-275, 1974), was an important contribution to the ever-expanding differential diagnosis of third nerve palsies.It should be emphasized that two distinct conditions coexisted in his patients. First, the posterior cerebral arteries arose from the internal carotid arteries; second and more important, arterial elongation and tortuosity were present. From the data cited by Dr. Scotti, it is apparent that the abnormal origin of the posterior cerebral arteries is fairly common and is, thus, not likely to be the primary cause of the oculomotor nerve palsies. It is, however, possible that the atypical origins resulted in an even more unusual course for the already enlarged posterior cerebral arteries.Dr. Richard Lindenberg and I published an illustration of an oculomotor nerve that had undergone atrophy due to pressure from enlarged
Sacks JG. Third Nerve Palsy. Arch Neurol. 1975;32(3):208. doi:10.1001/archneur.1975.00490450088015
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