Oculomotor palsy and drowsiness due to post-thrombectomy subarachnoid haemorrhage falsely suggesting transtentorial herniation
Introduction Post-thrombectomy subarachnoid haemorrhage (SAH) can result in oculomotor palsy and drowsiness, which may falsely suggest transtentorial herniation.Case presentation We present a case of right oculomotor nerve palsy presenting after endovascular thrombectomy (EVT) for a right middle cer...
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BMJ Publishing Group
2023-10-01
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| Series: | BMJ Neurology Open |
| Online Access: | https://neurologyopen.bmj.com/content/5/2/e000500.full |
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| author | Timothy Kleinig Logesh Palanikumar Joshua Mahadevan |
| author_facet | Timothy Kleinig Logesh Palanikumar Joshua Mahadevan |
| author_sort | Timothy Kleinig |
| collection | DOAJ |
| description | Introduction Post-thrombectomy subarachnoid haemorrhage (SAH) can result in oculomotor palsy and drowsiness, which may falsely suggest transtentorial herniation.Case presentation We present a case of right oculomotor nerve palsy presenting after endovascular thrombectomy (EVT) for a right middle cerebral artery (MCA) stroke. The patient presented with a significant right MCA syndrome and a National Institutes of Health Stroke Scale (NIHSS) score of 10 with CT perfusion demonstrating a large penumbral lesion and a CT angiogram confirming a right MCA M1 occlusion. After thrombectomy, the patient developed a 9mm dilated non-reactive right pupil, and a new ipsilateral near-complete oculomotor nerve palsy. Repeat code stroke imaging demonstrated perimesencephalic SAH). The patient was managed expectantly and her conscious state and oculomotor palsy gradually resolved with an excellent neurological recovery.Conclusion This case underscores the potential for post-thrombectomy perimesencephalic SAH as a rare mimic of symptomatic intracranial haemorrhage with mass effect manifesting as sudden-onset oculomotor nerve palsy. |
| format | Article |
| id | doaj-art-1e064ddd7c8b4fb5a82940bc0a10021e |
| institution | OA Journals |
| issn | 2632-6140 |
| language | English |
| publishDate | 2023-10-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Neurology Open |
| spelling | doaj-art-1e064ddd7c8b4fb5a82940bc0a10021e2025-08-20T02:18:04ZengBMJ Publishing GroupBMJ Neurology Open2632-61402023-10-015210.1136/bmjno-2023-000500Oculomotor palsy and drowsiness due to post-thrombectomy subarachnoid haemorrhage falsely suggesting transtentorial herniationTimothy Kleinig0Logesh Palanikumar1Joshua Mahadevan2Neurology, Royal Adelaide Hospital, Adelaide, South Australia, AustraliaNeurology, Royal Adelaide Hospital, Adelaide, South Australia, AustraliaNeurology, Royal Adelaide Hospital, Adelaide, South Australia, AustraliaIntroduction Post-thrombectomy subarachnoid haemorrhage (SAH) can result in oculomotor palsy and drowsiness, which may falsely suggest transtentorial herniation.Case presentation We present a case of right oculomotor nerve palsy presenting after endovascular thrombectomy (EVT) for a right middle cerebral artery (MCA) stroke. The patient presented with a significant right MCA syndrome and a National Institutes of Health Stroke Scale (NIHSS) score of 10 with CT perfusion demonstrating a large penumbral lesion and a CT angiogram confirming a right MCA M1 occlusion. After thrombectomy, the patient developed a 9mm dilated non-reactive right pupil, and a new ipsilateral near-complete oculomotor nerve palsy. Repeat code stroke imaging demonstrated perimesencephalic SAH). The patient was managed expectantly and her conscious state and oculomotor palsy gradually resolved with an excellent neurological recovery.Conclusion This case underscores the potential for post-thrombectomy perimesencephalic SAH as a rare mimic of symptomatic intracranial haemorrhage with mass effect manifesting as sudden-onset oculomotor nerve palsy.https://neurologyopen.bmj.com/content/5/2/e000500.full |
| spellingShingle | Timothy Kleinig Logesh Palanikumar Joshua Mahadevan Oculomotor palsy and drowsiness due to post-thrombectomy subarachnoid haemorrhage falsely suggesting transtentorial herniation BMJ Neurology Open |
| title | Oculomotor palsy and drowsiness due to post-thrombectomy subarachnoid haemorrhage falsely suggesting transtentorial herniation |
| title_full | Oculomotor palsy and drowsiness due to post-thrombectomy subarachnoid haemorrhage falsely suggesting transtentorial herniation |
| title_fullStr | Oculomotor palsy and drowsiness due to post-thrombectomy subarachnoid haemorrhage falsely suggesting transtentorial herniation |
| title_full_unstemmed | Oculomotor palsy and drowsiness due to post-thrombectomy subarachnoid haemorrhage falsely suggesting transtentorial herniation |
| title_short | Oculomotor palsy and drowsiness due to post-thrombectomy subarachnoid haemorrhage falsely suggesting transtentorial herniation |
| title_sort | oculomotor palsy and drowsiness due to post thrombectomy subarachnoid haemorrhage falsely suggesting transtentorial herniation |
| url | https://neurologyopen.bmj.com/content/5/2/e000500.full |
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