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.
References
![](https://www.ejcrim.com/public/journals/1/article_912_cover_en_US.jpg)
Views: 1594
HTML downloads: 354
PDF downloads: 457
Published:
2018-06-28
Issue:
Vol 5 No 8
(view)