抄録
An 18-year-old female was admitted following an automobile accident. She was confused and the left pupil was not reactive to light. Plain skull films and tomograms of the skull revealed a left frontal linear, vertical, skull fracture extending to the floor of the anterior fossa and the lateral aspect of the orbit. Blindness of the left eye was found, when the patient became alert. Five days later, left third, fourth and sixth-nerve palsies were noted. The patient became aphasic and right hemiparetic. A computerized tomography scan revealed a slightly low density area in the left fronto-temporal region and a round contrast-enhancing mass in the left cavernous sinus region. A left internal carotid angiogram showed a large aneurysm, 8×9×13 mm in size, in the cavernous portion and an early venous filling in the region of the frontal branches of the middle cerebral artery. Aphasia and the right hemiparesis gradually improved. Repeated angiography demonstrated a marked enlargement of the aneurysm despite a daily, Matas test maneuver. Surgery identified a lacerated optic nerve and fracture of the planum sphenoidale. The aneurysm was partially obliterated by copper wire thrombosis. One month after surgery, paralysis of the oculomotor and abducens nerves completely recovered.
