Mesencephalic cavernoma causing reversible nuclear third nerve palsy and obstructive hydrocephalus

We present a case of mesencephalic cavernoma, which caused various interesting clinical symptoms. A 58-year-old man was admitted to the emergency unit with a history of sudden, bilateral ptosis. Neurological examination revealed bilateral ptosis-limited elevation of both eyes, limited depression and adduction of the left eye, and a monocular abducting nystagmus in the right eye. Computed tomography showed a small hematoma in the mesencephalon and magnetic resonance imaging revealed a cavernoma with a hemorrhage. The patient was treated conservatively. Three months later, his bilateral ptosis had resolved and both the depression and the adduction of the left eye had improved. A year later, ocular motility had normalized. He subsequently presented with obstructive hydrocephalus; which was resolved with endoscopic third ventriculostomy.