Ayça ÖZKUL, Cengiz TATAROĞLU, Ali AKYOL, Utku Ogan AKYILDIZ, Kutsi KÖSEOĞLU

ORTA SEREBRAL ARTER ANEVRİZMASINA BAĞLI BiLATERAL ABDUSENS SİNİR PARALİZİSİ

Bilateral orta serebral arter anevrizmasına bağlı bilateral abdusens paralizisi olan bir olgumuzu nadir olmasınedeniyle sunmayı uygun gördük. 46 yaşında, kadın hasta altı gündür devam eden akut başlangıçlı, çok şiddetlibaşağrısı, bulantı ve çift görme şikayetleri ile acil servisimize başvurdu. Nörolojik muayenesinde ense sertliği,fundoskopide papil ödem olmaksızın sağda subhyaloid hemoraji ve bilateral abdusens paralizisi saptandı.Kranial MR normal olmakla birlikte beyin omurilik sıvısı ksantokromik idi. Acil yapılan serebral DSA'da sağda7mm, solda 10mm orta serebral anevrizmaya ait orta serebral arter sakkuler anevrizması görüldü.Anevrizmaların klipslenmesinden sonra 6. sinir paralizisinin gerilediği görüldü. Abdusens sinir paralizisi ayırıcıtanısında serebral anevrizmaya bağlı subaraknoid hemoraji de düşünülmelidir

Anahtar Kelimeler:

Subaraknoid hemoraji, abdusens nerve paralizisi, anevrizma

Bilateral Abducens Nerve Palsy Due To Middle Cerebral Artery Aneursym

We present a case of bilateral sixth nerve paralysis due to bilateral middle cerebral artery aneurysms.A46-yearold woman with severe headache, nausea and diplopia which had started six days before her admittance was found unconsious at home and admitted to our emergency unit. On neurological examination she was alert and had nuchal rigidity. There was no papil oedema but right subhyaloid hemorrhage in fundoscopy and bilateral abducens nerve paralysis. Although cranial magnetic resonance images (MRI) showed no neuropathology, cerebrospinal fluid (CSF) was xanthochromic. The emergency digital substraction angiography (DSA) demonstrated a 7mm at the right and 10mm at the left sacculer aneurysms of middle cerebral arteries. After successful clipping of aneursyms bilateral abducens nerve palsies resolved. Subarachnoid hemorrhage should be considered in differential diagnosis of abducens nerve paralysis.

Keywords:

Subarachnoid hemorrhage, abducens nevre palsy, aneurysm,

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