Neurovascular compression of the oculomotor nerve presenting with aberrant reinnervation

PURPOSE: To report a case of neurovascular compression in a patient presenting with ophthalmic evidence of aberrant reinnervation. OBSERVATION: A 68-year-old woman diagnosed with right partial third nerve palsy with aberrant regeneration. Suspicion was based on isolated clinical features of the right eye, including ptosis, upper eyelid elevation on adduction, mydriasis, exotropia, and hypotropia. Magnetic resonance imaging revealed atrophy of the right oculomotor nerve secondary to neurovascular compression from a prominent right superior cerebellar artery. CONCLUSION AND IMPORTANCE: This case highlights the importance of utilizing Fast Imaging Employing Steady-state Acquisition (FIESTA) for the diagnosis of oculomotor nerve palsy presenting with evidence of aberrant reinnervation.