Unilateral Abducens Nerve Palsy Associated with Ruptured Anterior Communicating Artery Aneurysm

Kim, Yeon Joon; Park, Cheol Wan; Yoo, Chung Sik; Kim, Eun Young; Kim, Jae Myoung; Kim, Woo-Kyung

doi:10.13004/kjnt.2012.8.2.146

Cited by 4 publications

(1 citation statement)

References 10 publications

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“…Although there has been six cases of CN III paresis associated with ACom aneurysms,[ 13 15 16 ] this is probably the first report of isolated involvement of the superior division of oculomotor nerve with sparing of pupils.…”

Section: Discussionmentioning

confidence: 98%

Pupil sparing oculomotor nerve paresis after anterior communicating artery aneurysm rupture: False localizing sign or acute microvascular ischemia?

Srinivasan¹,

Dhandapani²,

Kumar³

2015

Surg Neurol Int

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Background:We describe a rare case of solitary pupil sparing oculomotor nerve paresis following rupture of anterior communicating artery (ACom) aneurysm and discuss the pertinent literature. Oculomotor nerve paresis caused by an ACom aneurysm rupture is an uncommon occurrence. Also, partial paresis affecting only fibers of superior division of oculomotor nerve is never reported before.Case Description:A 55-year-old female, known hypertensive presented 5 days after an episode of acute severe headache, with Glasgow Coma Scale (GCS) of E2V2M5, left ptosis, normal pupils, paraparesis, and computed tomography (CT) scan showed diffuse subarachnoid hemorrhage (SAH). CT angiography revealed ACom aneurysm pointing antero-superiorly toward right. Patient later underwent endovascular coiling of the aneurysm. Subsequently there was partial improvement of ptosis in 3 weeks.Conclusion:Though pupil sparing oculomotor nerve paresis may not have much localizing value, it helps to understand acute microvascular spasm with potential therapeutic implications.

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Section: Discussionmentioning

confidence: 98%

Pupil sparing oculomotor nerve paresis after anterior communicating artery aneurysm rupture: False localizing sign or acute microvascular ischemia?

Srinivasan¹,

Dhandapani²,

Kumar³

2015

Surg Neurol Int

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Analyzing the relationship between cerebral aneurysms and Non-oculomotor cranial nerve palsies: a systematic review

Badary,

Helal,

Azab

et al. 2024

Neurosurg Rev

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This study aimed to investigate the association between intracerebral aneurysms and cranial nerve (CN) palsies, focusing on nerves other than the oculomotor nerve. It sought to determine the prevalence, risk factors, and clinical outcomes of these nerve palsies and compare the effectiveness of microsurgical clipping versus endovascular coiling in restoring nerve function. Methodology:Following PRISMA guidelines, a comprehensive literature search was conducted using databases like PubMed, Scopus, and Google Scholar, covering studies from 1975 to April 2024. The inclusion criteria targeted patients with non-oculomotor nerve palsies diagnosed with cerebral aneurysms. Studies published before 1975 and non-English studies were excluded. Data extraction included study design, patient characteristics, and intervention outcomes. The Joanna Briggs Institute and Newcastle-Ottawa scales were used to assess study quality. Data were synthesized narratively and statistically analysed using SPSS v27. ResultsThe analysis included 47 patients (53.2% female, mean age 44.8 years). The internal carotid artery (ICA) was the most common aneurysm site (44.7%), and the abducent nerve (CN VI) was most frequently affected. Ruptured aneurysms had better recovery outcomes (88.9%) than unruptured ones (66.7%). Hypertension was present in 9.2%. Unilateral aneurysms were seen in 80.9%, with 76.6% having a single nerve palsy. Non-ruptured aneurysms accounted for 58.1%, and ruptured for 41.9% of associated cranial nerve palsies. Treatment included microsurgical approaches (42.6%), endovascular approaches (34%), combined approaches (6.4%), and conservative management (17%). Recovery of the palsy was observed in 75.6%, with endovascular procedures showing higher recovery (93.3%) compared to conservative treatment (28.6%). ConclusionIntracerebral aneurysms are signi cantly associated with non-oculomotor CN palsies. Endovascular procedures yield higher recovery rates than conservative management, particularly in ruptured aneurysms. Timely and appropriate treatment is crucial for improving nerve function recovery in these patients.

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Analyzing the Relationship Between Cerebral Aneurysms and Non- Oculomotor Cranial Nerve Palsies: A Systematic Review

Badary,

Helal,

Azab

et al. 2024

Preprint

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Objectives This study aimed to investigate the association between intracerebral aneurysms and cranial nerve (CN) palsies, focusing on nerves other than the oculomotor nerve. It sought to determine the prevalence, risk factors, and clinical outcomes of these nerve palsies and compare the effectiveness of microsurgical clipping versus endovascular coiling in restoring nerve function. Methodology: Following PRISMA guidelines, a comprehensive literature search was conducted using databases like PubMed, Scopus, and Google Scholar, covering studies from 1975 to April 2024. The inclusion criteria targeted patients with non-oculomotor nerve palsies diagnosed with cerebral aneurysms. Studies published before 1975 and non-English studies were excluded. Data extraction included study design, patient characteristics, and intervention outcomes. The Joanna Briggs Institute and Newcastle-Ottawa scales were used to assess study quality. Data were synthesized narratively and statistically analysed using SPSS v27. Results The analysis included 47 patients (53.2% female, mean age 44.8 years). The internal carotid artery (ICA) was the most common aneurysm site (44.7%), and the abducent nerve (CN VI) was most frequently affected. Ruptured aneurysms had better recovery outcomes (88.9%) than unruptured ones (66.7%). Hypertension was present in 9.2%. Unilateral aneurysms were seen in 80.9%, with 76.6% having a single nerve palsy. Non-ruptured aneurysms accounted for 58.1%, and ruptured for 41.9% of associated cranial nerve palsies. Treatment included microsurgical approaches (42.6%), endovascular approaches (34%), combined approaches (6.4%), and conservative management (17%). Recovery of the palsy was observed in 75.6%, with endovascular procedures showing higher recovery (93.3%) compared to conservative treatment (28.6%). Conclusion Intracerebral aneurysms are significantly associated with non-oculomotor CN palsies. Endovascular procedures yield higher recovery rates than conservative management, particularly in ruptured aneurysms. Timely and appropriate treatment is crucial for improving nerve function recovery in these patients.

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Unilateral Abducens Nerve Palsy Associated with Ruptured Anterior Communicating Artery Aneurysm

Cited by 4 publications

References 10 publications

Pupil sparing oculomotor nerve paresis after anterior communicating artery aneurysm rupture: False localizing sign or acute microvascular ischemia?

Pupil sparing oculomotor nerve paresis after anterior communicating artery aneurysm rupture: False localizing sign or acute microvascular ischemia?

Analyzing the relationship between cerebral aneurysms and Non-oculomotor cranial nerve palsies: a systematic review

Analyzing the Relationship Between Cerebral Aneurysms and Non- Oculomotor Cranial Nerve Palsies: A Systematic Review

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