Giant intracavernous carotid aneurysm presenting as isolated sixth nerve palsy in an infant

Giant intracavernous carotid aneurysms (ICCAA) are extremely rare in the paediatric population. Ophthalmic symptoms from ICCAA are caused by pressure of the aneurysm wall on surrounding structures and depend on the location, size and direction of growth. We report a case of giant ICCAA that presented as an isolated sixth nerve palsy in an infant. A full-term previously healthy 5-month-old boy presented with 1 month of worsening incomitant right esotropia that measured 25Δ in primary gaze. Abduction of the right eye beyond midline was severely limited. The remaining ophthalmic and medical examinations were normal. He had episodic non-projectile vomiting and an upper respiratory tract infection 2 weeks prior to presentation. His paternal great grandfather and grandfather had died of aortic dissection in their mid adulthood. Computed tomographic angiography and …