Abstract
BackgroundBilateral and isolated abducens nerve palsy is a rare initial presentation after aneurysms rupture. Several possible mechanisms including intracranial hypertension have been purposed. To date, there have been no reports with objective measurements to demonstrate the relationship between intracranial pressure and isolated abducens palsy in the setting of acute subarachnoid hemorrhage due to aneurysm rupture.FindingsA 50 year-old female presented with severe headache and bilaterally isolated abducens nerve palsy. A series of image studies showed a ruptured aneurysm over right internal carotid artery and posterior communicating artery bifurcation with minimal subarachnoid hemorrhage. Surgery of aneurysm clipping was performed and intracranial pressure monitoring was applied. Postoperatively no new neurological deficit developed but persistent headache and increased intracranial pressure measured by a fiber-optic device had been observed. The intracranial hypertension then decreased gradually with rapid recovery from the bilateral abducens palsy 7 days after the surgery. The relationship between postoperative intracranial pressure, subarachnoid hematoma and isolated abducens palsy are illustrated.ConclusionsThe report demonstrated the clinical presentation of bilaterally isolated abducens palsy after an intracranial aneurysm rupture is related with the increased intracranial pressure level, rather than the hematoma compression to the nerve or vasospasm of pontine branches of basilar artery.
Highlights
Bilateral and isolated abducens nerve palsy is a rare initial presentation after aneurysms rupture
The report demonstrated the clinical presentation of bilaterally isolated abducens palsy after an intrac‐ ranial aneurysm rupture is related with the increased intracranial pressure level, rather than the hematoma compres‐ sion to the nerve or vasospasm of pontine branches of basilar artery
*Correspondence: suyufeng2000@gmail.com †Tse-Lun Wang and Chieh-Hsin Wu contributed 1 Department of Neurosurgery, Kaohsiung Medical University Hospital, No 100, Tz‐you 1st Road, Kaohsiung 807, Taiwan Full list of author information is available at the end of the article subarachnoid hemorrhage and subdural hematoma were considered with undetermined causes
Summary
Bilateral and isolated abducens nerve palsy is a rare initial presentation after aneurysms rupture. Conclusions: The report demonstrated the clinical presentation of bilaterally isolated abducens palsy after an intrac‐ ranial aneurysm rupture is related with the increased intracranial pressure level, rather than the hematoma compres‐ sion to the nerve or vasospasm of pontine branches of basilar artery. *Correspondence: suyufeng2000@gmail.com †Tse-Lun Wang and Chieh-Hsin Wu contributed 1 Department of Neurosurgery, Kaohsiung Medical University Hospital, No 100, Tz‐you 1st Road, Kaohsiung 807, Taiwan Full list of author information is available at the end of the article subarachnoid hemorrhage and subdural hematoma were considered with undetermined causes.
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