J Korean Neurosurg Soc.  2009 Apr;45(4):240-242. 10.3340/jkns.2009.45.4.240.

Oculomotor Nerve Palsy Associated with Rupture of Middle Cerebral Artery Aneurysm

• Kim SC
• Chung J
• Lim YC
• Shin YS

• KMID: 1466295
• DOI: http://doi.org/10.3340/jkns.2009.45.4.240

Abstract

Oculomotor nerve palsy (ONP) with subarachnoid hemorrhage (SAH) occurs usually when oculomotor nerve is compressed by growing or budding of posterior communicating artery (PcoA) aneurysm. Midbrain injury, increased intracranial pressure (ICP), or uncal herniation may also cause it. We report herein a rare case of ONP associated with SAH which was caused by middle cerebral artery (MCA) bifurcation aneurysm rupture. A 58-year-old woman with clear consciousness suffered from headache and sudden onset of unilateral ONP. Computed tomography showed SAH caused by the rupture of MCA aneurysm. The unilateral ONP was not associated with midbrain injury, increased ICP, or uncal herniation. The patient was treated with coil embolization, and the signs of oculomotor nerve palsy completely resolved after a few days. We suggest that bloody jet flow from the rupture of distant aneurysm other than PcoA aneurysm may also be considered as a cause of sudden unilateral ONP in patients with SAH.

Keyword

Oculomotor nerve palsy; Middle cerebral artery aneurysm; Subarachnoid hemorrhage

MeSH Terms

Aneurysm
Arteries
Consciousness
Female
Headache
Humans
Intracranial Aneurysm
Intracranial Pressure
Mesencephalon
Middle Aged
Middle Cerebral Artery
Oculomotor Nerve
Oculomotor Nerve Diseases
Rupture
Subarachnoid Hemorrhage