Facharzt FMH Neurochirurgie Practice Questions - Facharzt FMH Für Neurochirurgie Spécialiste FMH En Neurochirurgie Exam

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A 56-year-old man presents with an acute, severe retro-orbital headache, ipsilateral ptosis, a dilated and non-reactive pupil, and an eye positioned 'down and out'. Emergent diagnostic workup demonstrates a 9 mm saccular aneurysm originating at the junction of the internal carotid artery and posterior communicating artery (ICA-PCoA). What is the primary pathophysiological mechanism of the cranial nerve deficit, and what is the urgency of intervention?

Ischemic infarction of the central core of CN VI; elective outpatient management in 4–6 weeks Microvascular diabetic mononeuropathy sparing the pupillomotor fibers; observation without imaging Trigeminal nerve (V1) compression within the superior orbital fissure; urgent radiation therapy Direct mechanical compression of the peripheral pupillomotor parasympathetic fibers on the outer surface of CN III; urgent surgical or endovascular aneurysm exclusion

Correct Answer:

Direct mechanical compression of the peripheral pupillomotor parasympathetic fibers on the outer surface of CN III; urgent surgical or endovascular aneurysm exclusion

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