[Abduction of the eyeballs palsy as a first sign of subarachnoid hemorrhage from ruptured posterior inferior cerebellar artery aneurysm: a case report].

The authors present a rare case of the abduction of the eyeballs palsy caused by subarachnoid hemorrhage from ruptured posterior-inferior cerebellar artery aneurysm, which appeared as a first sign of hemorrhage. Aneurysm was clipped. During three days after the operation, oculomotor lesions appeared persistent, no consciousness deterioration or other focal signs were observed. On the third day after the operation asystolic cardiac arrest appeared. Control CT scan did not reveal any pathological changes responsible for such deterioration. The patient died. In our case after an analysis of the mechanism and pathophysiology of this lesion in our opinion that palsy might be caused by influence of extravasated blood after hemorrhage. This thesis is adequate to the reviewed literature on this problem. Nevertheless, the compression of the abducent nerve as the reason cannot be excluded, e.g. rapid enlargement of the aneurysm or the compression of the brain stem near the nerve. Posthemorrhagic lesion of the brain stem may have been the reason of this lesion, caused by penetration of the blood into the ventricle during subarachnoidal hemorrhage. Although these lesions are very rare, subarachnoid hemorrhage should be taken into consideration when the patient with eyeballs abduction palsy is admitted to a neurosurgical or neurological department.