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Case Reports
. 2023 Dec 13;11(12):e5452.
doi: 10.1097/GOX.0000000000005452. eCollection 2023 Dec.

The Telltale Botox: Botulinum Toxin Injection by an Expert Hand as an Intracranial Aneurysm Detector

Giorgio Caddia  1 , Giulio J Jaber  1 , Francesca Granata  2 , Karol Galletta  2 , Antonio Pitrone  2 , Paolino La Spina  3 , Ferdinando Stagno d'Alcontres  4 , Francesco Stagno d'Alcontres  1
Affiliations
Case Reports

The Telltale Botox: Botulinum Toxin Injection by an Expert Hand as an Intracranial Aneurysm Detector

Giorgio Caddia et al. Plast Reconstr Surg Glob Open. .

Abstract

Complications in aesthetic medicine can be considered a consequence of the inexperience of the performing physician, but in some cases, they can unveil far more serious conditions, hitherto silent. We present a case of a 48-year-old patient who, following botulinum toxin type A (Botox) injection for treatment of forehead wrinkles, returned to our attention 12 days later for a discrete, newly onset right eyelid ptosis. This ptosis was a telltale sign of the presence of an intracranial aneurysm closely related with the oculomotor nerve. The lack of compensatory action by the frontalis muscle in maintaining the eyelid in position allowed us to highlight the extrinsic compression deficit of the oculomotor nerve. Subsequently, the patient underwent endovascular treatment of the aneurysm, leading to complete resolution of the case.

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Conflict of interest statement

The authors have no financial interest to declare in relation to the content of this article.

Figures

Fig. 1.
Fig. 1.
A photograph of the patient after treatment showing blepharoptosis of the right eye after botox treatment.
Fig. 2.
Fig. 2.
Magnetic resonance imaging and MRA at clinical onset: coronal high-resolution T2-weighted image (A) and volume rendering MRA (B) show a small unruptured aneurysm of the supraclinoid tract of right internal carotid artery (red arrows). A close anatomical relationship between the aneurysmal sac and the oculomotor nerve (yellow arrow) was depicted.
Fig. 3.
Fig. 3.
A photograph of the patient 3 months after the endovascular treatment, showing complete resolution of the case.
See this image and copyright information in PMC

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