Unilateral Oculomotor Nerve Dysfunction Induced by Ruptured Anterior Communicating Artery Aneurysm along with Isolated Intraventricular Hemorrhage in a Trauma Patient

Background: Many signs in relation to vascular events and consequent loss of consciousness could be easily incorrectly explained (unclear) in a setting of trauma, especially when these events are a result of the car accident. Third cranial nerve palsy widely occurs due to internal carotid and posterior communicating artery aneurysm. An anterior communicating(ACOM) aneurysm is a rare reason that could lead to oculomotor dysfunction. ACOM ruptured aneurysm may present with sub arachnoid hemorrhage (SAH) and intraventricular hemorrhage (IVH) but isolated IVH is a rare finding for ACOM ruptured aneurysm. Case Description: A ۵۶-year-old male presented to the hospital emergency department because of trauma after a car accident. He was unconscious with left-sided dilated pupil and ptosis with a brain CT indicating IVH. Brain CT angiography that performed two weeks after the accident revealed ACOM aneurysm. The patient underwent craniotomy and clipping the aneurysm. He was discharged, after completing the period of the following treatmentA combination of neuropathic agents and opioids helped to control pain. These analgesic included amitriptyline, gabapentin, pregabalin, tramadol and morphine in various regimens. Paracetamol and ibuprofen were also used. Conclusion: This report is a unique case of synchronization of third cranial nerve palsy and isolated IVH without SAH due to ACOM aneurysm. In addition, it could be interesting to re-emphasize the need for a comprehensive assessment of traumatic patients for finding some primary pathologies, which could result in an accident.

Keywords:

Third nerve palsy , Anterior communicating artery aneurysm , Intraventricular hemorrhage , subarachnoid hemorrhage , car accident