J Korean Neurosurg Soc.  2013 Feb;53(2):112-114. 10.3340/jkns.2013.53.2.112.

Slowly Recovering Isolated Bilateral Abducens Nerve Palsy after Embolization of Ruptured Anterior Communicating Artery Aneurysm

• Jeon JS
• Lee SH
• Son YJ
• Chung YS

• KMID: 2190688
• DOI: http://doi.org/10.3340/jkns.2013.53.2.112

Abstract

Bilateral abducens nerve palsy related to ruptured aneurysm of the anterior communicating artery (ACoA) has only been reported in four patients. Three cases were treated by surgical clipping. No report has described the clinical course of the isolated bilateral abducens nerve palsy following ruptured ACoA aneurysm obliterated with coil. A 32-year-old man was transferred to our institution after three days of diplopia, dizziness and headache after the onset of a 5-minute generalized tonic-clonic seizure. Computed tomographic angiography revealed an aneurysm of the ACoA. Magnetic resonance imaging showed focal intraventricular hemorrhage without brain stem abnormalities including infarction or space-occupying lesion. Endovascular coil embolization was conducted to obliterate an aneurysmal sac followed by lumbar cerebrospinal fluid (CSF) drainage. Bilateral paresis of abducens nerve completely recovered 9 weeks after ictus. In conclusion, isolated bilateral abducens nerve palsy associated with ruptured ACoA aneurysm may be resolved successfully by coil embolization and lumbar CSF drainage without directly relieving cerebrospinal fluid pressure by opening Lillequist's membrane and prepontine cistern.

Keyword

Anterior communicating artery; Subarachnoid hemorrhage; Abducens nerve palsy

MeSH Terms

Abducens Nerve
Abducens Nerve Diseases
Aneurysm
Aneurysm, Ruptured
Angiography
Arteries
Brain Stem
Cerebrospinal Fluid Pressure
Diplopia
Dizziness
Drainage
Headache
Hemorrhage
Humans
Infarction
Intracranial Aneurysm
Magnetic Resonance Imaging
Membranes
Paresis
Seizures
Subarachnoid Hemorrhage
Surgical Instruments

Figure

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  Fig. 1 Initial CT shows no definite high density lesion in the basal cisterns (A), but CTA reveals an aneurysm of ACoA (white arrow) (B). Axial T2WI MR reveals a focal low signal (white arrows) of the posterior horn of the lateral ventricle which may represent intraventricular hemorrhage (C) without diffusion restriction of the brain stem (D). Three-dimensional-reconstructed digital subtraction angiography image demonstrates a bilobulated saccular aneurysm of ACoA (white arrow) (E). ACoA : anterior communicating artery.

• 

  Fig. 2 A : Initial photograph reveals isolated bilateral sixth-nerve palsy (Rt.>Lt.). B : Twelve days later, a photograph demonstrates the improvement in both sixth-nerve paresis, in particular, right side. C : Signs of diplopia were resolved completely 9 weeks after development.

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