Fig. 22. A. A 72-year-old man with slowly progressive left ophthalmoplegia. Note paresis of left medial, lateral, superior, and inferior recti. Left pupil showed inextensive motor function. Left lid retraction on downward gaze (pseudo-vonGraefe phenomenon) indicates oculomotor “misdirection.” B. Left carotid arteriogram demonstrates large intracavernous aneurysm (A). C. Similar left intracavernous aneurysm (A) displayed on coronal MRI; note partial thrombosis (T) surrounded by signal void. (P, pituitary gland)