title: Slowly recovering isolated bilateral abducens nerve palsy after embolization of ruptured anterior communicating artery aneurysm.
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.
authors.affiliation: Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.
authors.forename: Jin Sue
authors.initials: JS
authors.lastname: Jeon
authors.forename: Sang Hyung
authors.initials: SH
authors.lastname: Lee
authors.forename: Young-Je
authors.initials: YJ
authors.lastname: Son
authors.forename: Young Seob
authors.initials: YS
authors.lastname: Chung
keywords: Abducens nerve palsy; Anterior communicating artery; Subarachnoid hemorrhage
references.citation: Ophthalmology. 2004 Feb;111(2):369-75
references.pmid: 15019392
references.citation: Neurol Med Chir (Tokyo). 1992 Jan;32(1):17-20
references.pmid: 1375980
references.citation: Acta Neurochir (Wien). 2003 Feb;145(2):159-61; discussion 161
references.pmid: 12601466
references.citation: Semin Ophthalmol. 2007 Jan-Mar;22(1):21-4
references.pmid: 17366113
references.citation: Neurocirugia (Astur). 2007 Oct;18(5):420-2
references.pmid: 18008016
references.citation: J Pak Med Assoc. 2007 Sep;57(9):468-70
references.pmid: 18072644
references.citation: Semin Neurol. 2009 Feb;29(1):14-28
references.pmid: 19214929
references.citation: Arch Ophthalmol. 1981 Jan;99(1):76-9
references.pmid: 7458744
references.citation: Acta Neurochir Suppl. 2011;110(Pt 2):183-7
references.pmid: 21125469
references.citation: Am J Ophthalmol. 1966 May;61(5 Pt 2):1293-8
references.pmid: 5938012