Isolated third nerve palsy associated with a ruptured anterior communicating artery aneurysm.

Abstract:

INTRODUCTION:An oculomotor palsy in the setting of aneurysmal subarachnoid hemorrhage is often due to compression by a posterior communicating artery aneurysm. Anterior communicating artery (ACOM) aneurysms may produce ophthalmologic symptoms of the anterior visual pathways, but rarely ever lead to a 3rd nerve palsy. This report describes a rare case of an isolated oculomotor palsy in a patient who experienced subarachnoid hemorrhage from an ACOM aneurysm. CLINICAL PRESENTATION:A 46-year-old male presented to the emergency department with headache, emesis, and an isolated left third nerve palsy-the remainder of his exam was normal. A head CT showed diffuse subarachnoid hemorrhage that was later attributed to an ACOM aneurysm as determined by angiography. INTERVENTION:Due to the configuration of the aneurysm, it was not deemed treatable by endovascular means. Following a successful clipping, the patient experienced a delayed, transient, monocular visual loss. Upon follow-up, his oculomotor palsy had completely resolved. CONCLUSION:In very rare circumstances, an ACOM aneurysm may produce an isolated third nerve palsy. The etiology of the palsy is likely related to clot formation and/or irritating blood products.

journal_name

Neurocrit Care

journal_title

Neurocritical care

authors

White JB,Layton KF,Cloft HJ

doi

10.1007/s12028-007-0054-4

subject

Has Abstract

pub_date

2007-01-01 00:00:00

pages

260-2

issue

3

eissn

1541-6933

issn

1556-0961

journal_volume

7

pub_type

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