PMID- 28720746
OWN - NLM
STAT- MEDLINE
DCOM- 20171130
LR  - 20171130
IS  - 0301-2603 (Print)
IS  - 0301-2603 (Linking)
VI  - 45
IP  - 7
DP  - 2017 Jul
TI  - [A Rare Case of Ruptured Internal Carotid-Posterior Communicating Artery Aneurysm 
      Associated with Contralateral Delayed Oculomotor Nerve Palsy].
PG  - 629-635
LID - 10.11477/mf.1436203562 [doi]
AB  - A 55-year-old man presented with difficulty breathing, chest pain, and 
      disturbance of consciousness, and was transferred to our hospital. Initial whole 
      body CT revealed a diffuse subarachnoid hemorrhage(SAH)with severe pulmonary 
      edema that was considered neurogenic in origin. He received controlled 
      ventilation under sedation and conservative care for the SAH. One day after the 
      onset of the SAH, his left pupil suddenly became dilated to 6mm, with no reaction 
      to light. Head CT showed no new bleeding. Subsequent CT angiogram revealed a 
      right internal carotid-posterior communicating artery aneurysm(IC-PC AN)with a 
      posterior-lateral projection; however, no vessel abnormality was observed in the 
      left anterior or posterior circulations. The aneurysm was successfully treated 
      with coil embolization. We reviewed reported cases of isolated oculomotor nerve 
      palsy(ONP), without direct compression by ruptured aneurysms, and found that only 
      11 cases exist, including our case. Interestingly, six of them were associated 
      with anterior communicating artery aneurysms. A mass effect, chemical 
      stimulation, and a jet stream of blood were proposed as the mechanisms of this 
      rare type of ONP, in addition to the specific neurovascular relationships between 
      the oculomotor nerve and the posterior cerebral/posterior communicating/superior 
      cerebellar arteries, with abnormal nerve contact or compression. Though rare, 
      ruptured IC-PC ANs could cause contralateral ONP; other types of ruptured 
      aneurysms may also lead to indirect effects on nervous structures without direct 
      compression. This type of rare presentation of ruptured aneurysms should be 
      considered, especially in cases of multiple aneurysms, such as IC-PC ANs.
FAU - Somagawa, Chika
AU  - Somagawa C
AD  - Residency Program, National Hospital Organization, Nagasaki Medical Center.
FAU - Fukuda, Yutaka
AU  - Fukuda Y
FAU - Yoshimura, Shota
AU  - Yoshimura S
FAU - Satoh, Kei
AU  - Satoh K
FAU - Hiu, Takeshi
AU  - Hiu T
FAU - Ono, Tomonori
AU  - Ono T
FAU - Ushijima, Ryujirou
AU  - Ushijima R
FAU - Toda, Keisuke
AU  - Toda K
FAU - Tsutsumi, Keisuke
AU  - Tsutsumi K
LA  - jpn
PT  - Case Reports
PT  - Journal Article
PT  - Review
PL  - Japan
TA  - No Shinkei Geka
JT  - No shinkei geka. Neurological surgery
JID - 0377015
SB  - IM
MH  - Aneurysm, Ruptured/*diagnostic imaging/etiology
MH  - Humans
MH  - Intracranial Aneurysm/complications/*diagnostic imaging
MH  - Male
MH  - Middle Aged
MH  - Oculomotor Nerve Diseases/*diagnostic imaging/etiology
MH  - Subarachnoid Hemorrhage/*diagnostic imaging/etiology
MH  - Tomography, X-Ray Computed
EDAT- 2017/07/20 06:00
MHDA- 2017/12/01 06:00
CRDT- 2017/07/20 06:00
PHST- 2017/07/20 06:00 [entrez]
PHST- 2017/07/20 06:00 [pubmed]
PHST- 2017/12/01 06:00 [medline]
AID - 1436203562 [pii]
AID - 10.11477/mf.1436203562 [doi]
PST - ppublish
SO  - No Shinkei Geka. 2017 Jul;45(7):629-635. doi: 10.11477/mf.1436203562.