J Korean Neurosurg Soc.  2010 May;47(5):392-394. 10.3340/jkns.2010.47.5.392.

Isolated, Contralateral Trochlear Nerve Palsy Associated with a Ruptured Right Posterior Communicating Artery Aneurysm

• Son S
• Park CW
• Yoo CJ
• Kim EY
• Kim JM

• KMID: 2066781
• DOI: http://doi.org/10.3340/jkns.2010.47.5.392

Abstract

Trochlear nerve palsy associated with spontaneous subarachnoid hemorrhage (SAH) is known to be a rare malady. We report here on a patient who suffered with left trochlear nerve palsy following rupture of a right posterior communicating artery aneurysm. A 56-year-woman visited our emergency department with stuporous mental change. Her Hunt-and-Hess grade was 3 and the Fisher grade was 4. Cerebral angiography revealed a ruptured aneurysm of the right posterior communicating artery. The aneurysm was clipped via a right pterional approach on the day of admission. The patient complained of diplopia when she gazed to the left side, and the ophthalmologist found limited left inferolateral side gazing due to left superior oblique muscle palsy on day 3. Elevated intracranial pressure, intraventricular hemorrhage or a dense clot in the basal cisterns might have caused this trochlear nerve palsy.

Keyword

Posterior communicating artery aneurysm; Trochlear nerve paresis; Subarachnoid hemorrhage

MeSH Terms

Aneurysm
Aneurysm, Ruptured
Arteries
Cerebral Angiography
Diplopia
Emergencies
Hemorrhage
Humans
Intracranial Aneurysm
Intracranial Hypertension
Muscles
Paralysis
Rupture
Stupor
Subarachnoid Hemorrhage
Trochlear Nerve
Trochlear Nerve Diseases