J Cerebrovasc Endovasc Neurosurg.  2024 Sep;26(3):318-323. 10.7461/jcen.2024.E2023.07.002.

Isolated ipsilateral abducens nerve palsy and contralateral homonymous hemianopsia associated with unruptured posterior cerebral artery aneurysm: A rare neurological finding

• Mishra S
• Mishra S
• Regmi S
• Garg K
• Gaikwad S

• KMID: 2559443
• DOI: http://doi.org/10.7461/jcen.2024.E2023.07.002

Abstract

Cranial nerve palsies can be presenting signs of intracranial aneurysms. There is a classic pairing between an aneurysmal vessel and adjacent nerves leading to cranial neuropathy. Isolated abducens nerve palsy can be a localizing sign of an unruptured vertebrobasilar circulation aneurysm. Aneurysms involving Anterior Inferior Cerebellar Artery (AICA) and Posterior Inferior Cerebellar Artery (PICA) have been reported to be associated with abducens nerve palsy. The symptoms in unruptured aneurysms are due to the mass effect on adjacent neurovascular structures. Most of the abducens nerve palsy resolves following microsurgical clipping. Here, we present a rare case of an unruptured Posterior Cerebral Artery (PCA) aneurysm presenting with abducens nerve palsy and diplopia associated with contralateral hemianopsia which markedly improved following endovascular coil embolization.

Keyword

Abducens nerve palsy; Homonymous hemianopsia; Intracranial aneurysm; Posterior cerebral artery

Figure

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  Fig. 1. (A, B) Non-enhanced CT Scan Head showing a hyperdense lesion in the left crural cistern. Left PCA territory infarct without SAH. (C, D, E) Areas of subacute infarct in left PCA territory involving left cuneus and posterior cingulate cortex with hemorrhagic transformation and cortical laminar necrosis involving left cuneus, likely emboli from aneurysm. Partially thrombosed dissecting fusiform aneurysm involving left proximal P2 PCA, with mild mass effect and edema involving adjacent ventral left hemipons. CT, computed tomography; PCA, posterior cerebral artery; SAH, subarachnoid hemorrhage

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  Fig. 2. (A, B) Angiogram showing large dissecting fusiform aneurysm measuring 7.51 mm×8.75 mm×7.99 mm seen involving P1-P2 PCA. (C, D) Post-coiling angiogram showing complete occlusion of the P1-P2 PCA aneurysm with multiple detachable coils. PCA, posterior cerebral artery

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  Fig. 3. (A) Post-coiling non contrast CT scan showing hypodensity (right>left) in pons likely post coiling edema. (B) Post-coiling non contrast CT scan of the PCA aneurysm showing radio artifact of the coils. CT, computed tomography; PCA, posterior cerebral artery

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