Oculomotor Nerve Palsy in Association with a Ruptured Internal Carotid Artery Bifurcation Aneurysm: Case Report / 대한뇌혈관외과학회지

We report a rare case of third cranial nerve palsy due to a ruptured left internal carotid artery (ICA) bifurcation aneurysm. A 70-year-old man was stuporous with left ophthalmoplegia (unilaterally fixed dilated pupil, abducted eyes, and ptosis). A computed tomography demonstrated extensive hemorrhage spreading around the left sylvian fissure and basal cistern with a ipsilateral predominance, and intraventricular hemorrhage without focal mass effect. A computed tomographic angiography demonstrated a 3mm sized aneurysmal sac which arose from the left ICA bifurcation. The aneurysmal clipping was performed at 1 day after onset. In operative field, there was no direct compression of the oculomotor nerve by the aneurysmal fundus. Postoperatively, he recovered to alert mental status, but left ophthalmoplegia recovered partially at the 1 year follow-up.

Clinical Features and Surgical Results of ICA Bifurcation Aneurysms

OBJECTIVE: The aneurysms developed at internal carotid artery(ICA) bifurcation can be different from other aneurysms because there are many perforating arteries and the hemodynamic changes are characteristic. In this report, we present our cases of ICA bifurcation aneurysms and discuss the clinical features and surgical outcomes of these aneurysms. METHODS: From January 1989 to May 2001, total 808 patients(982 aneurysms) were operated for intracranial aneurysms at our hospital. Among them, twenty two patients(2.7%) had aneurysms at ICA bifurcation. We discussed clinical features according to mental status at admission, size, direction and multiplicity of aneurysms, presence of intracranial hemorrhage and rupture of ICA bifurcation aneurysms. And we also discussed the surgical results of operations depending on pre-operative Hunt-Hess grade and size of aneurysms. RESULTS: Mean age was 43.4 years old and 10 cases(45.5%) were below 40 years old. Six patients(27.2%) had large or giant aneurysms. Fifteen(68.2%) out of 22 patients had good results, 1 fair, 1 poor and 5 dead. CONCLUSION: In our ICA bifurcation aneurysm cases, we conclude that their onset is relative in younger age, and they has a higher incidence of multiple(34.6%) and larger aneurysm(27.2%) than other anterior circulatory aneurysm. And the surgical results of ICA bifurcation aneurysm are relatively poor.

ICA Bifurcation Aneurysm: Clinical Features and Surgical Outcome

OBJECTIVE: Aneurysms at the internal carotid artery(ICA) bifurcation are uncommon and account for about 3 to 5% of all intracranial aneurysms. Moreover, the surgical treatment of these aneurysms has been discussed in detail only by a few authors. In this report, we present our experienced cases, and discuss the clinical features and surgical outcome of these aneurysms. METHOD: In the last eight years, out of total of 672 patients operated for intracranial aneurysms at our hospital, 17 patients(2.5%) had aneurysms at the ICA bifurcation. The direction of aneurysms were distinguished based upon DaPian's classification; superior, anterior, or posterior. RESULT: There were female preponderance(M:F=1:1.8) and the left side predominance(11 of 17 cases). Nine patients had multiple aneurysms, and in that cases ICA bifurcation aneurysms were responsible for hemorrhage in most cases. All aneurysms were clipped via the standard pterional approach. Thirteen out of 17 patients had good results and 2 patients fair results; the surgical outcome was favorable in 88.2% of cases. One who had rebleeding before surgery died. CONCLUSION: It is presumed that the perforator occlusion and intraoperative aneurysmal rupture were the main factors aggravating the surgical outcome. In cases with anteriorly- or posteriorly-projecting aneurysm, more careful cautions would be necessary.

Paraplegia:An Initial Manifestation of a Ruptured ICA Bifurcation Aneurysm

A case of sudden paraplegia as the first symptom of a ruptured internal carotid artery bifurcation aneurysm is reported. Sudden appearance of paraparesis or paraplegia is an exceptional event in patients with intracranial aneurysms. The various pathogenic mechanisms are briefly discussed. Insufficient blood perfusion of both paracentral areas was the cause of paraplegia in this case.