Bilateral abducens nerve palsy associated with subarachnoid hemorrhage

Abstract

Bilateral abducens nerve palsy in association with SAH is rarely described. Proposed mechanisms include direct compression of the bilateral abducens nerves, vasospasm of the pontine branches of the basilar artery and hydrocephalous. Most of the patients in our series showed resolution of the symptoms over a period of 4-9 weeks.

Bilateral Abducent Nerve Palsy: Not Always a False Localising Sign

“…The occurrence of bilateral abducent nerve palsy is often considered palsy, gaze palsy and facial palsy due to close association between the sixth, seventh nerve and medial longitudinal fasciculus [1,[3][4][5]. In the present case, as intracranial pressure was normal and no aneurysm was evident on CT and conventional angiogram, the most likely explanation for occurrence of bilateral sixth nerve palsy is direct compression of the nerve by the extensive clot in the prepontine cistern.…”

“…as a false localising sign [1]. This false localising sign is evident in the presence of raised intracranial pressure [1].…”

“…Also as no gaze palsy or facial palsy was evident in the present case, vasospasm of the pontine branches of basilar artery is unlikely to have caused bilateral abducent nerve palsy. Prognosis in these patients depends on the cause of the abducent nerve palsy as well as the neurological status [1,2].…”

Relationship between abducens nerve palsy and local hematoma in a case series of ruptured vertebral artery dissecting aneurysm

“…We were able to identify 14 previous studies, which investigated the cause of abducens nerve palsy in cases of ruptured VA dissecting aneurysms [ Table 3 ]. [ 1 2 3 4 6 7 8 9 10 11 12 13 14 15 ] The following etiologies have been postulated: (1) direct compression by aneurysm;[ 1 9 ] (2) direct mechanical pressure of hematoma;[ 3 4 6 11 12 ] (3) vasospasm of the pontine branches of the basilar artery;[ 16 ] (4) direct arterial jetting caused by aneurysmal rupture, adjacent to the nerve;[ 2 ] (5) increased ICP due to acute hydrocephalus. [ 10 14 ]…”

Bilateral Abducens Nerve Paresis Associated with Aneurysmal Subarachnoid Hemorrhage: Report of Two Cases

“…Recovery time is reported to last 3 to 9 weeks and 3 to 6 months after bleeding [3,11]. Ziyal et al [3] indicates shorter periods due to fenestration of Liliequist membrane, as well as CSF circulation improves in the prepontine cistern.…”