Aneurysm of the Internal Carotid Artery Pressing on Dorello’s Canal in a Patient with Bilateral Abducens Nerve Palsy: Case Report
Abstract
Objective: Abducens nerve palsy (ANP) has an incidence of 11.3/100,000. ANP related to pressure of the aneurysm on the Dorello’s canal is unusual. We report a case of bilateral ANP following head trauma.
Case: A 31-year-old woman was admitted for the evaluation of diplopia began after trauma. In the diagnostic imaging; the magnetic resonance imaging (MRI) revealed the normal course of bilateral abducens nerve (AN) in the pontine cistern. The adjacent anatomy of the right AN from pons up to the oculer bulb was normal. But the distal part of the left ICA petrous segment at the level of foramen lacerum had a remarkable loss of signal void. Multidetector computed tomography angiogram demonstrated a left distal petrous ICA aneurysm which was under the Dorello’s canal and remodeling the clivus.
Conclusion: We estimated the left ANP was caused by the pressure of the aneurysm. And the right ANP was probably due to the trauma the patient had experienced.
Keywords
References
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Details
Primary Language
English
Subjects
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Journal Section
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Authors
Ferhat Cuce
This is me
Cem Ozgonul
This is me
Ozgur Bulent Oztimucin
This is me
Samet Verim
This is me
Publication Date
September 15, 2016
Submission Date
June 25, 2016
Acceptance Date
-
Published in Issue
Year 2016 Volume: 3 Number: 9