[A Case of Contralateral Oculomotor Nerve Palsy due to Internal Carotid Artery-Anterior Choroidal Artery Ruptured Aneurysm].

Sudden oculomotor palsy with severe headache is known to suggest a ruptured ipsilateral internal carotid artery aneurysm. We encountered a case of contralateral oculomotor nerve palsy due to internal carotid artery-anterior choroidal artery ruptured aneurysm. A 63-year-old woman presented with severe headache and sudden right oculomotor palsy. Computed tomography(CT)showed subarachnoid hemorrhage, and three-dimensional CT showed a left internal carotid artery-anterior choroidal artery aneurysm. We performed neck clipping via a left pterional approach. After the surgery, right oculomotor palsy was not observed. We think the causes of oculomotor nerve palsy in this case were hematoma and elevated intracranial pressure. Once these factors were removed, we think that oculomotor nerve palsy was not observed.

[Delayed Traumatic Intracerebral Hematoma during Antiplatelet Therapy after Operations for Ruptured Left ICPC Aneurysm and Right Traumatic Epidural Hematoma: A Case Report].

Delayed traumatic intracerebral hematoma (DTICH) is a rare complication of head injury that appears suddenly after an interval of several days or months. Here, we report a case of DTICH during antiplatelet therapy for vasospasm following surgeries for a ruptured left internal carotid-posterior communicating (ICPC) aneurysm and right acute epidural hematoma (EDH). A 77-year-old man with no medical history was diagnosed with a subarachnoid hemorrhage (SAH) due to rupturing of a left ICPC aneurysm and a right linear fracture of the right parietal bone due to a head injury following the rupture. On day 2, the patient underwent successful clipping of the left ICPC aneurysm. Computed tomography (CT) performed post-clipping revealed a right acute EDH below the linear fracture of the right parietal bone, which was removed immediately. A next-day CT revealed minor contusions in both temporal poles. Fasudil, ozagrel, and cilostazol were administered from Day 3 post-clipping and EDH evacuation to prevent vasospasm. The contusions did not enlarge until Day 10. On Day 11, the patient became comatose, and a huge hematoma was identified in the right temporal lobe to frontal lobe. Although the hematoma was removed immediately, the patient died on Day 13. The hematoma was considered to be a rare case of DTICH that developed from a minor contusion of the right temporal lobe during antiplatelet therapy for vasospasm. In cases of aneurysmal SAH with head injury and contusion, we must pay attention to DTICH and select more deliberate treatment for vasospasm.