# Isolated Third Cranial Nerve Palsy Following Coronary Angiography: A Rare Neuro-Ophthalmologic Complication

## TL;DR

A rare case of third cranial nerve palsy occurred after a heart procedure, highlighting the need for awareness of such complications.

## Contribution

Reports a rare neuro-ophthalmologic complication following coronary angiography.

## Key findings

- A 51-year-old male developed left third cranial nerve palsy after coronary angiography.
- MRI showed recent lacunar infarcts along the oculomotor nerve, suggesting an embolic cause.
- Early detection and preventive measures are crucial for managing such rare complications.

## Abstract

Neurological complications following cardiac coronary angiography (CAG), such as ischemic stroke and neuro-ophthalmologic syndromes, are uncommon but significant. This report presents a rare case of isolated third cranial nerve palsy that developed after CAG, highlighting the potential risks associated with the procedure. A 51-year-old male with a history of hypertension and ischemic heart disease underwent CAG for non-ST-segment elevation myocardial infarction. Although the procedure and subsequent cardiac imaging results were normal, the patient developed sudden onset binocular diplopia, ptosis, and restricted eye movements in his left eye following CAG, indicative of left third cranial nerve palsy. Initial computed tomography (CT) and computed tomography angiography (CTA) scans were unremarkable, but a magnetic resonance imaging (MRI) revealed multiple recent lacunar infarcts, including one along the path of the left oculomotor nerve, suggesting an embolic cause. Neuro-ophthalmologic complications post-CAG, though rare, require early detection and intervention, emphasizing the need for preventive measures in at-risk patients.