PMC6379881_01
Preoperative plain Computed Tomogram scan of the brain showing subarachnoid hemorrhage.
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Societies grade I). She underwent plain Computed Tomogram (CT) scan of the brain, which showed subarachnoid hemorrhage (SAH) in the left sylvian fissure and interhemispheric fissure (Modified Fisher grade 1) (Figure 1). Suspecting an aneurysmal SAH, she was admitted in neurosurgery intensive care unit and was started on antiedema measures, anticonvulsant, analgesic, and Nimodipine.
Computed Tomogram Angiography films showing the anterior communicating artery aneurysm.
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The next day, she underwent CT cerebral angiogram, which revealed a bilobed anterior communicating artery aneurysm, projecting anterosuperiorly and measuring 8 x 7 x 5 mm in size (Figure 2).
Postoperative plain Computed Tomogram scan of the brain showing the absence of hematoma or infarct.
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An emergency CT scan of the brain was taken which revealed only postoperative changes (Figure 3).
Photograph showing the right sided ptosis due to oculomotor nerve palsy.
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But her oculomotor nerve palsy persisted and was painful (Figure 4).
Photograph showing the manually lifted right eye lid demonstrating mydriasis and impaired adduction of right eye.
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But pupillary size remained the same (Figure 5).
Photograph showing the resolved oculomotor palsy with full adduction of right eye.
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On the 61st postoperative day, her ptosis suddenly disappeared on waking up and when she came for follow-up in outpatient department, her ONP had fully recovered (Figure 6).