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Posterior communicating artery aneurysm presenting with ipsilateral oculomotor nerve palsy

dEscription A 62-year-old gentleman presented with a repeated history of headaches which resolved spontaneously. He developed right-sided facial pain with gradual-onset right-sided ptosis and diplopia. The facial pain originated behind the right ear, with radiation across the face. Magnetic resonance imaging revealed a 9 mm × 4 mm saccular, posterior-directed posterior communicating artery (PCOM) aneurysm [Figures 1 and 2]. Right craniotomy followed by clipping of the right PCOM was performed. Following surgery, he had immediate relief of facial pain and significant improvement of oculomotor nerve palsy (ONP).