ABSTRACT
Isolated abducens nerve paresis related to ruptured vertebral artery (VA) aneurysm is rare. It usually occurs bilaterally or ipsilaterally to the pathologic lesions. We report the case of a contralateral sixth nerve palsy following ruptured dissecting VA aneurysm. A 38-year-old man was admitted for the evaluation of a 6-day history of headache. Abnormalities were not seen on initial computed tomography (CT). On admission, the patient was alert and no signs reflecting neurologic deficits were noted. Time of flight magnetic resonance angiography revealed a fusiform dilatation of the right VA involving origin of the posterior inferior cerebellar artery. The patient suddenly suffered from severe headache with diplopia the day before the scheduled cerebral angiography. Neurologic examination disclosed nuchal rigidity and isolated left abducens nerve palsy. Emergent CT scan showed high density in the basal and prepontine cistern compatible with ruptured aneurismal hemorrhage. Right vertebral angiography illustrated a right VA dissecting aneurysm with prominent displaced vertebrobasilar artery to inferiorly on left side. Double-stent placement was conducted for the treatment of ruptured dissecting VA aneurysm. No diffusion restriction signals were observed in follow-up magnetic resonance imaging of the brain stem. Eleven weeks later, full recovery of left sixth nerve palsy was documented photographically. In conclusion, isolated contralateral abducens nerve palsy associated with ruptured VA aneurysm may develop due to direct nerve compression by displaced verterobasilar artery triggered by primary thick clot in the prepontine cistern.
Subject(s)
Humans , Abducens Nerve , Abducens Nerve Diseases , Aneurysm , Aortic Dissection , Angiography , Arteries , Brain Stem , Cerebral Angiography , Diffusion , Dilatation , Diplopia , Follow-Up Studies , Headache , Hemorrhage , Magnetic Resonance Angiography , Magnetic Resonance Imaging , Muscle Rigidity , Neurologic Examination , Neurologic Manifestations , Paresis , Subarachnoid Hemorrhage , Vertebral ArteryABSTRACT
[Objective] To observe the cure effect of routine massage and vibration on vertebra artery cervical spondylosis.[Method] Treat 152 cases with focal routine massage of shoulder combined with key acupoints vibration of head and abdomen for 10 times,and then observe the cure effect.[Result] 48 cases were cured,95 better,9 had no effect;the total effective rate was 94.07%.[Conclusion] The vibration can rouse and notify tri-jiao Qi,making normal rise and fall of Qi function,helpful to blood and Qi function of brain;it can increase the cure effect being combined with focal massage of shoulder.