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Isolated, Contralateral Trochlear Nerve Palsy Associated with a Ruptured Right Posterior Communicating Artery Aneurysm

  • Son, Seong (Department of Neurosurgery, Gachon University, Gil Hospital) ;
  • Park, Cheol-Wan (Department of Neurosurgery, Gachon University, Gil Hospital) ;
  • Yoo, Chan-Jong (Department of Neurosurgery, Gachon University, Gil Hospital) ;
  • Kim, Eun-Young (Department of Neurosurgery, Gachon University, Gil Hospital) ;
  • Kim, Jae-Myoung (Department of Neurosurgery, Gachon University, Gil Hospital)
  • 투고 : 2009.02.12
  • 심사 : 2010.05.03
  • 발행 : 2010.05.28

초록

Trochlear nerve palsy associated with spontaneous subarachnoid hemorrhage (SAH) is known to be a rare malady. We report here on a patient who suffered with left trochlear nerve palsy following rupture of a right posterior communicating artery aneurysm. A 56-year-woman visited our emergency department with stuporous mental change. Her Hunt-and-Hess grade was 3 and the Fisher grade was 4. Cerebral angiography revealed a ruptured aneurysm of the right posterior communicating artery. The aneurysm was clipped via a right pterional approach on the day of admission. The patient complained of diplopia when she gazed to the left side, and the ophthalmologist found limited left inferolateral side gazing due to left superior oblique muscle palsy on day 3. Elevated intracranial pressure, intraventricular hemorrhage or a dense clot in the basal cisterns might have caused this trochlear nerve palsy.

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참고문헌

  1. Burger LJ, Kalvin NH, Smith JL : Acquired lesion of the fourth cranial nerve. Brain 93 : 567-574, 1970. https://doi.org/10.1093/brain/93.3.567
  2. Collins TE, Mehalic TF, White TK, Pezzuti RT : Trochlear nerve palsy as the sole initial sign of an aneurysm of the superior cerebellar aretery. Neurosurgery 30 : 258-261, 1992 https://doi.org/10.1227/00006123-199202000-00020
  3. Fahmy JA : Symptoms and signs of intracranial aneurysms with particular reference to retinal haemorrhage. Acta Ophthalmol (Copenh) 50 : 129-136, 1972
  4. Hall JK, Jacobs DA, Movsas T, Galetta SL : Fourth nerve palsy, homonymous hemianopia, and hemisensory deficit caused by a proximal posterior cerebral artery aneurysm. J Neuroophthalmol 22 : 95-98, 2002 https://doi.org/10.1097/00041327-200206000-00006
  5. Hoya K, Kirino T : Traumatic trochlear nerve palsy following minor occipital impact--four case reports. Neurol Med Chir (Tokyo) 40 : 358-360, 2000 https://doi.org/10.2176/nmc.40.358
  6. Kwartz J, Leatherbarrow B, Davis H : Diplopia following headinjury. Injury 21 : 351-352, 1990 https://doi.org/10.1016/0020-1383(90)90116-C
  7. Laun A, Tonn JC : Cranial nerve lesions following subarachnoid hemorrhage and aneurysm of the circle of Willis. Neurosug Rev 11 : 137-141, 1988 https://doi.org/10.1007/BF01794677
  8. Lee CH, Koh YC : Ruptured posterior communicating artery aneurysm causing bilateral abducens nerve paralyses - case report : J Korean Neurosurg Soc 29 : 426-429, 2000
  9. Mansour AM, Reinecke RD : Central trochlear palsy. Surv Ophthalmol 30 : 279-297, 1986 https://doi.org/10.1016/0039-6257(86)90061-5
  10. Marinkovic S, Gibo H, Zelic O, Nicodijevic I : The neurovascular relationships and the blood supply of the trochlear nerve : surgical anatomy of its cisternal segment. Neurosurgery 38 : 161-169, 1996 https://doi.org/10.1097/00006123-199601000-00036
  11. Plum F, Posner JB : The diagnosis of stupor and coma. 3rd ed. Philadelphia : Fa Davis, 1980, pp113-114
  12. Prosst RL, Majetschak M : Traumatic unilateral trochlear nerve palsy. J Trauma 62 : E1-E3, 2007 https://doi.org/10.1097/01.ta.0000232057.36209.03
  13. Rucker CW : The causes of paralysis of ther third, fourth, and sixth cranial nerves. Am J Ophthalmol 61 : 1293-1298, 1966 https://doi.org/10.1016/0002-9394(66)90258-3
  14. Rush JA, Younge BR : Paralysis of cranial nerves III, IV, and VI. Cause and prognosis in 1,000 cases. Arch Ophthalmol 99 : 76-79, 1981 https://doi.org/10.1001/archopht.1981.03930010078006
  15. von Noorden GK, Murray E, Wong SY : Superior oblique paralysis. A review of 270 cases. Arch Ophthalmol 104 : 1771-1776, 1986 https://doi.org/10.1001/archopht.1986.01050240045037
  16. Yasargil MG : Microneurosurgery I Stuttgart : Georg Thieme Verlag, 1984, pp39-46, 133-134.