Acute Isolated Sixth Nerve Palsy Caused by Unruptured Intradural Saccular Aneurysm.
Acute Isolated Sixth Nerve Palsy Caused by Unruptured Intradural Saccular Aneurysm.
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未破裂硬膜内囊状动脉瘤引起的急性孤立性第六神经麻痹。
DOI：
10.1097/wno.0000000000000782
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发表时间：
2019
期刊：
影响因子：
--
通讯作者：
Trobe,JonathanD
中科院分区：
文献类型：
--
作者：
Walter,Eyal;Liao,EricA;DeLott,LindseyB;Trobe,JonathanD
背景：引起孤立性第六神经麻痹的未破裂颅内动脉瘤通常位于海绵窦外或作为母动脉梭状扩张的一部分。椎基底动脉循环的硬膜内囊状动脉瘤是一种罕见但危及生命的孤立性第六神经麻痹的原因。我们提供了2个这样的案例。方法：密歇根大学神经眼科门诊病例记录。结果：一名56岁女性，有动脉硬化风险，报告了新的复视，并有孤立的左第六神经麻痹，由小脑前下动脉未破裂的囊状动脉瘤引起。成功缠绕，第六神经麻痹明显好转。一名62岁女性，有动脉硬化风险，新发复视，因较大未破裂的椎动脉动脉瘤引起孤立性右第六神经麻痹。它被盘绕起来，后来支架化和后缩。这些手术分离了动脉瘤，缓解了第六神经麻痹。结论：这2例有动脉硬化风险的老年患者的孤立性第六神经麻痹是由未破裂的硬膜内椎基底动脉瘤引起的。在决定是否需要对孤立性第六神经麻痹进行脑成像时，本报告为一种罕见的现象提供了证据。
Background:Unruptured intracranial aneurysms that cause isolated sixth nerve palsies are usually located extradurally in the cavernous sinus or intradurally as part of fusiform enlargement of the parent artery. Intradural saccular aneurysms of the vertebrobasilar circulation are a rare but life-threatening cause of isolated sixth nerve palsy. We provide documentation of 2 such cases.Methods:Case records of the Neuro-ophthalmology Clinics at the University of Michigan.Results:A 56-year-old woman with an arteriosclerotic risk profile reported new diplopia and had an isolated left sixth nerve palsy caused by an unruptured saccular aneurysm of the anterior inferior cerebellar artery. It was successfully coiled, and the sixth nerve palsy markedly improved. A 62-year-old woman with an arteriosclerotic risk profile and new diplopia had an isolated right sixth nerve palsy caused by a large unruptured vertebral artery aneurysm. It was coiled and later stented and recoiled. These procedures isolated the aneurysm and relieved the sixth nerve palsy.Conclusions:Isolated sixth nerve palsies in these 2 older adult patients with arteriosclerotic risk profiles were caused by unruptured intradural vertebrobasilar aneurysms. This report adds documentation to a rare phenomenon that must be taken into consideration in deciding whether brain imaging is needed in isolated sixth nerve palsy.