ABSTRACT
Oculomotor nerve palsy due to a venous varix arising from flow anomalies caused by a dural arteriovenous fistula (AVF) is a rare phenomenon. We report a case of surgical third nerve palsy with a rare underlying AVF as the cause and discuss in detail the patho-anatomy and its significance. A tentorial dural AVF mimicking the arterial circle was found with multiple varix formation causing compressive oculomotor palsy. This was treated successfully with Onyx™ injection with a satisfactory angiographic result and complete resolution of symptoms.
Subject(s)
Central Nervous System Vascular Malformations/pathology , Cerebral Veins/pathology , Oculomotor Nerve Diseases/pathology , Varicose Veins/pathology , Aged , Central Nervous System Vascular Malformations/complications , Central Nervous System Vascular Malformations/surgery , Cerebral Veins/diagnostic imaging , Cerebral Veins/surgery , Humans , Male , Oculomotor Nerve Diseases/etiology , Radiography , Varicose Veins/etiology , Varicose Veins/surgeryABSTRACT
The incidence of aneurysmal subarachnoid haemorrhage (SAH) in the UK is about 10 per 100 000 of the population per year and it is a potentially fatal condition. Prompt recognition and referral to a neurosurgical unit is crucial for a better outcome. A typical history of sudden severe headache, CT scan and sometimes a lumbar puncture would help clinch the diagnosis. Though intracerebral haemorrhage (ICH) and intraventricular haemorrhage (IVH) are not uncommon after an aneurysmal rupture, ICH and/or IVH without SAH are rare (<2%). In such cases, a high index of suspicion is needed to deliver the correct management. This report describes a case of posterior communicating artery aneurysm presenting with pure IVH on CT. The aneurysm was diagnosed by performing a CT angiogram and the patient underwent a successful coil embolisation.
