Forty-nine patients with oculomotor nerve palsy due to intracranial aneurysm were examined. The reversal of third nerve palsy is related to modality of onset and surgical timing: "early" surgery (within 14 days from the onset of oculomotor palsy) promises a better prognosis for ocular function; recovery starting within the first month will probably be complete. A full recovery is probably seen only with conduction block (neuroapraxia) or minor axonal changes (axonolysis). Clinical features of third nerve palsy due to intracranial aneurysms versus other causes of oculomotor palsy are discussed.