Complete third nerve palsy as a presenting feature of an interpeduncular lipoma

Background: Intracranial lipomas are rare, benign lesions, of congenital origin commonly found incidentally on imaging studies. Methods: We describe a case of interpeduncular lipoma in an 18 year-old female presenting with a painful left complete oculomotor (IIIrd) nerve palsy and associated headache, which to the best of our knowledge has not been reported in an adult patient. Results: Following eye patching and steroid treatment, at 6-week follow-up the patient's pain had significantly improved however the complete IIIrd nerve palsy remained. Conclusions: Evidence suggests improvement will occur regardless with conservative management independent of radiological changes to the lipoma.