title: Bilaterally isolated abducens palsy after an aneursym rupture is related with intracranial hypertension.
abstract: BACKGROUND
  Bilateral 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.
  
  
  RESULTS
  A 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.
  
  
  CONCLUSIONS
  The 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.
authors.affiliation: Department of Neurosurgery, Kaohsiung Medical University Hospital, No 100, Tz-you 1st Road, Kaohsiung, 807 Taiwan.|Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Tse-Lun
authors.initials: TL
authors.lastname: Wang
authors.affiliation: Department of Neurosurgery, Kaohsiung Medical University Hospital, No 100, Tz-you 1st Road, Kaohsiung, 807 Taiwan.|Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Chieh-Hsin
authors.initials: CH
authors.lastname: Wu
authors.affiliation: Division of Traumatology, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Chao-Wen
authors.initials: CW
authors.lastname: Chen
authors.affiliation: Department of Neurosurgery, Kaohsiung Medical University Hospital, No 100, Tz-you 1st Road, Kaohsiung, 807 Taiwan.|Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Tai-Hsin
authors.initials: TH
authors.lastname: Tsai
authors.affiliation: Department of Neurosurgery, Kaohsiung Medical University Hospital, No 100, Tz-you 1st Road, Kaohsiung, 807 Taiwan.|Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Sui-Sum
authors.initials: SS
authors.lastname: Kung
authors.affiliation: Department of Neurosurgery, Kaohsiung Medical University Hospital, No 100, Tz-you 1st Road, Kaohsiung, 807 Taiwan.
authors.forename: Chia-Hung
authors.initials: CH
authors.lastname: Chao
authors.affiliation: Department of Neurosurgery, Kaohsiung Medical University Hospital, No 100, Tz-you 1st Road, Kaohsiung, 807 Taiwan.|Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.|Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Chih-Lung
authors.initials: CL
authors.lastname: Lin
authors.affiliation: Department of Neurosurgery, Kaohsiung Medical University Hospital, No 100, Tz-you 1st Road, Kaohsiung, 807 Taiwan.|Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Yu-Feng
authors.identifier: 0000-0003-0355-3981
authors.initials: YF
authors.lastname: Su
keywords: Abducens palsy; Intracranial pressure; Neuromonitoring; Ruptured aneurysm; Subarachnoid hemorrhage