Cranial nerve lesions following subarachnoid hemorrhage and aneurysm of the circle of willis

Abstract

Fifty-eight of 570 patients with an aneurysm and/or subarachnoid hemorrhage displayed palsy of one or several cranial nerves. In 48 patients, this lesion occurred in the context of SAH (total n = 534). The oculomotor nerve was most frequently affected (38 cases), followed by the abducens nerve with the second-highest incidence (18 cases). The highest rate of cranial nerve symptoms occurred in cases of ophthalmic carotid aneurysms (83.3%). Damage to the abducens nerve regressed most rapidly.

Isolated third nerve palsy associated with a ruptured anterior communicating artery aneurysm

“…An ACOM aneurysm that produces an isolated third nerve palsy is extraordinarily rare [6][7][8][9]. In the few cases where an ACOM aneurysm was thought to produce a 3rd nerve palsy, it did so in the setting of subarachnoid hemorrhage with an eventual resolution of the paresis [6,9].…”

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

“…Aneurysms of the ophthalmic artery, posterior communicating artery, internal carotid artery, basilar artery, superior cerebellar artery (SCA) and the posterior cerebral artery (PCA) have been documented to cause trochlear nerve palsy 1,3,4,7,14) . All of these reports noted the location of aneurysm may itself have placed pressure on the trochlear nerve.…”

Complete Isolated Third Nerve Paresis Assosicated With Fusiform Dilatation of Middle Cerebral Artery

“…If meningeal signs are present, spinal fluid evaluation is warranted. A fully dilated and non-reactive pupil occurs in up to 71% of patients with aneurysmal compression and TNP (1,(4)(5)(6).…”