Bilateral Third Nerve Palsy in Mirror Aneurysms of the Posterior Communicating Arteries
  • Enrique Gomez-Figueroa
    Vascular Neurology Department, Instituto Nacional de Neurologia y Neurocirugia, Mexico City, Mexico
  • Omar Cardenas-Saenz
    Vascular Neurology Department, Instituto Nacional de Neurologia y Neurocirugia, Mexico City, Mexico
  • Gerardo Quiñones-Pesqueira
    Vascular Neurology Department, Instituto Nacional de Neurologia y Neurocirugia, Mexico City, Mexico
  • Roberto Cervantes-Uribe
    Vascular Neurology Department, Instituto Nacional de Neurologia y Neurocirugia, Mexico City, Mexico
  • Juan Manuel Calleja-Castillo
    Vascular Neurology Department, Instituto Nacional de Neurologia y Neurocirugia, Mexico City, Mexico

Keywords

Third nerve palsy, oculomotor nerve palsy, subarachnoid hemorrhage, mirror aneurysm, thunderclap headache

Abstract

Background: Bilateral third cranial nerve palsy has only been reported in a handful of conditions including some with inflammatory, tumoural and vascular causes. An urgent imaging study is mandatory to rule out vascular aetiology, mainly aneurysmal subarachnoid haemorrhage (aSAH).
Case presentation: A 28-year-old Hispanic woman presented to the emergency department with a 21-day history of a sudden-onset and severe headache that on three occasions was accompanied by transient loss of awareness, the last episode occurring a week previously. The simple CT image showed minimal bleeding at the level of the perimesencephalic cisterns, with evidence of SAH. An angioCT revealed a 5×6 mm bilobed saccular aneurysm of the right posterior communicating artery and a 2×2 mm saccular aneurysm in the posterior left communicating artery.
Conclusions: A mirror aneurysm is found in 2–25% of aSAH cases. To date there is no consensus about the optimal management of patients with these findings.

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    Published: 2018-06-28
    Issue: Vol 5 No 8 (view)


    How to cite:
    1.
    Gomez-Figueroa E, Cardenas-Saenz O, Quiñones-Pesqueira G, Cervantes-Uribe R, Calleja-Castillo JM. Bilateral Third Nerve Palsy in Mirror Aneurysms of the Posterior Communicating Arteries. EJCRIM 2018;5 doi:10.12890/2018_000912.

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