Oculomotor Nerve Palsy in Internal Carotid-Posterior Communicating Artery Aneurysm

Internal carotid-posterior communicating artery aneurysms are frequently related to third nerve palsy which is reversible after the clipping of aneurysm. The authors had analyzed 61 cases in 52 patients who have posterior communicating artery aneurysm and evaluated the factors affecting the development of third nerve palsy and its recovery after clipping of the aneurysm. The results are followings 1) Oculomotor nerve palsy was noticed in 10 patients(16.4%) among 61 cases of posterior communicating artery aneurysm, of which 6 had complete and 4 had partial palsies. 2) Posteriolateral inferior direction of the aneurysm seemed to be closely related to the development of ophthalmoplegia. 3) Development of ophthalmoplegia was not related to the clinical status of the patient on admission, but to the amount of subarachnoid hemorrhage on initial CT scan and size of the aneurysm. 4) Preoperative degree of third nerve palsy and the timing of operation are not definitely related to the recovery of ophthalmoplegia. 5) The recovery of third nerve palsy are normalization of ptosis, normalization of EOM limitation and normalization of papillary change in order.

Management for Undetermined Subarachnoid Hemorrhage

It is known that the prognosis of spontaneous SAH(subarachnoid hemorrhage) of undetermined cause is generally favorable. Yet, the natural history and pathogenesis of SAH of undetermined cause remain controversial and patients management is largely empirical. 42 cases of non-traumatic SAH of undetermined cause of a total of 415 cases of SAH treated during a 5-year period(1991-1996) were available for this study. What should be done when angiography is negative after SAH? This study was undertaken to present a more definitive management in preventing rebleeding after SAH of undetermined cause. This study show that explorative craniotomy for aneurysmal operation is warranted, despite negative cerebral panangiograms, if the patient manifests the classical signs and symptoms of SAH and definite subarachnoid blood in CT(computed tomogram) or direct lumbar puncture and any suspicious lesions in cerebral panangiography, particularly the AcoA(anterior communicating artery) region.