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Contained Rupture of a Posterior Communicating Artery Aneurysm in a Patient With a Third Nerve Palsy.
Dhoot, Arjan S; Guest, William C; Bharatha, Aditya; Micieli, Jonathan A.
  • Dhoot AS; Faculty of Medicine (ASD), University of Toronto, Toronto, Canada; Department of Medical Imaging (WCG, AB), Division of Neuroradiology, St. Michael's Hospital, University of Toronto, Toronto, Canada; and Department of Ophthalmology and Vision Sciences (JAM), St. Michael's Hospital, University of Toronto, Toronto, Canada.
J Neuroophthalmol ; 41(4): e761-e763, 2021 Dec 01.
Article in English | MEDLINE | ID: covidwho-1232245
Semantic information from SemMedBD (by NLM)
1. Oculomotor Nerve Paralysis PROCESS_OF Patients
Subject
Oculomotor Nerve Paralysis
Predicate
PROCESS_OF
Object
Patients
2. Rupture PROCESS_OF Patients
Subject
Rupture
Predicate
PROCESS_OF
Object
Patients
3. Magnetic Resonance Angiography ADMINISTERED_TO Patients
Subject
Magnetic Resonance Angiography
Predicate
ADMINISTERED_TO
Object
Patients
4. Neuroimaging ADMINISTERED_TO Patients
Subject
Neuroimaging
Predicate
ADMINISTERED_TO
Object
Patients
5. Computed Tomography Angiography ADMINISTERED_TO Patients
Subject
Computed Tomography Angiography
Predicate
ADMINISTERED_TO
Object
Patients
6. Vomiting PROCESS_OF Patients
Subject
Vomiting
Predicate
PROCESS_OF
Object
Patients
7. Headache PROCESS_OF C0030705
Subject
Headache
Predicate
PROCESS_OF
Object
C0030705
8. Blepharoptosis AFFECTS Oculomotor Nerve Paralysis
Subject
Blepharoptosis
Predicate
AFFECTS
Object
Oculomotor Nerve Paralysis
9. Computed Tomography Angiography DIAGNOSES Berry Aneurysm
Subject
Computed Tomography Angiography
Predicate
DIAGNOSES
Object
Berry Aneurysm
10. Temporal Lobe LOCATION_OF Hematoma
Subject
Temporal Lobe
Predicate
LOCATION_OF
Object
Hematoma
11. Oculomotor Nerve Paralysis PROCESS_OF Patients
Subject
Oculomotor Nerve Paralysis
Predicate
PROCESS_OF
Object
Patients
12. Rupture PROCESS_OF Patients
Subject
Rupture
Predicate
PROCESS_OF
Object
Patients
13. Magnetic Resonance Angiography ADMINISTERED_TO Patients
Subject
Magnetic Resonance Angiography
Predicate
ADMINISTERED_TO
Object
Patients
14. Neuroimaging ADMINISTERED_TO Patients
Subject
Neuroimaging
Predicate
ADMINISTERED_TO
Object
Patients
15. Computed Tomography Angiography ADMINISTERED_TO Patients
Subject
Computed Tomography Angiography
Predicate
ADMINISTERED_TO
Object
Patients
16. Vomiting PROCESS_OF Patients
Subject
Vomiting
Predicate
PROCESS_OF
Object
Patients
17. Headaches, severe PROCESS_OF Patients
Subject
Headaches, severe
Predicate
PROCESS_OF
Object
Patients
18. Blepharoptosis AFFECTS Oculomotor Nerve Paralysis
Subject
Blepharoptosis
Predicate
AFFECTS
Object
Oculomotor Nerve Paralysis
19. Computed Tomography Angiography DIAGNOSES Berry Aneurysm
Subject
Computed Tomography Angiography
Predicate
DIAGNOSES
Object
Berry Aneurysm
20. Temporal Lobe LOCATION_OF Hematoma
Subject
Temporal Lobe
Predicate
LOCATION_OF
Object
Hematoma
ABSTRACT
ABSTRACT It is recommended that every patient with a new third nerve palsy undergo urgent neuroimaging (computed tomography angiography or magnetic resonance angiography) to exclude a posterior communicating artery aneurysm. Because of the novel coronavirus (COVID-19) pandemic, our institution noted a significant decline in the number of patients with aneurysmal subarachnoid hemorrhage presenting to the hospital. We report one such example of a patient who developed new-onset severe headache and vomiting and did not seek medical attention because of COVID-19. Two months later, she was noted to have ptosis during a routine follow-up and was found to have a complete, pupil-involving third nerve palsy. Computed tomography angiography was performed and revealed an irregular bilobed saccular aneurysm (7 × 9 × 5 mm) of the right posterior communicating (PComm) artery, but no acute hemorrhage was visible on CT. On MRI, immediately adjacent to the aneurysm, there was a small subacute hematoma in the right medial temporal lobe with surrounding vasogenic edema. This case had a fortunate and unique outcome as she had a contained hematoma adjacent to the ruptured PComm aneurysm and did not experience severe morbidity from the subarachnoid hemorrhage nor did she rebleed in the interval in which she did not seek care. This case highlights the importance of providing neuro-ophthalmic care even during a pandemic.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Oculomotor Nerve Diseases / Intracranial Aneurysm / Aneurysm, Ruptured / COVID-19 Type of study: Case report Topics: Long Covid Limits: Aged / Female / Humans Language: English Journal: J Neuroophthalmol Journal subject: Neurology / Ophthalmology Year: 2021 Document Type: Article Affiliation country: WNO.0000000000001224

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Oculomotor Nerve Diseases / Intracranial Aneurysm / Aneurysm, Ruptured / COVID-19 Type of study: Case report Topics: Long Covid Limits: Aged / Female / Humans Language: English Journal: J Neuroophthalmol Journal subject: Neurology / Ophthalmology Year: 2021 Document Type: Article Affiliation country: WNO.0000000000001224