J Korean Med Sci.  2007 Feb;22(1):173-176. 10.3346/jkms.2007.22.1.173.

Ruptured Anterior Communicating Artery Aneurysm Causing Bilateral Oculomotor Nerve Palsy: A Case Report

• Kang SD

• KMID: 1713263
• DOI: http://doi.org/10.3346/jkms.2007.22.1.173

Abstract

A rare case of bilateral third cranial nerve palsy due to a ruptured anterior communicating artery aneurysm is presented. A 68-yr-old woman was semicomatose with bilaterally fixed dilated pupil, abducted eyes, and ptosis. A computed tomography demonstrated extensive hemorrhage spreading around the both Sylvian and interhemisheric fissure without focal mass effect. Intracranial pressure via extraventricular drainage before surgery was 15-50 mmHg. Three months later, brain MRI showed infarction of left posterior cerebral artery territory and lacuna infarction of the pons. Eleven months after aneurysm repair, nerve palsy improved slowly and recovered partially. The patient communicated well with simple words. The author reviewed and discussed the possible mechanism of this rare neuro-ophthalmological manifestation in view of a false localizing sign.

Keyword

Oculomotor Nerve; Paralysis; Palsy; Anterior Communicating Artery; Intracranial Aneurysm

MeSH Terms

Rupture, Spontaneous
Oculomotor Nerve Diseases/*etiology
Magnetic Resonance Imaging
Intracranial Aneurysm/*complications/surgery
Humans
Female
Aged

Figure

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  Fig. 1 Computed tomographic scanning demonstrates extensive hemorrhage spreading around the both Sylvian, basal, and interhemispheric cistern.

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  Fig. 2 A digital subtraction angiogram reveals a saccular aneurysm on the anterior communicating artery.

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  Fig. 3 Three months after surgery, a follow-up magnetic resonance imaging demonstrates infarction of the left medial occipital lobe (A) and lacunar infarction of the pons (B).

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  Fig. 4 Postoperative photograph by one year follow-up shows lateral deviation in the right eye, centrally fixed pupil in the left eye, and both isocoric and reactive pupils.

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