Cranial Nerve Palsies and Peri-Mesencephalic Subarachnoid Haemorrhage: A Case Report and Review of the Literature.

Peri-mesencephalic subarachnoid haemorrhage (PMSAH) is considered to be a clinically benign subset of subarachnoid haemorrhage (SAH). Cranial nerve palsies have been previously reported as rare sequelae of PMSAH. Herein, we report an unusual case of multiple cranial nerve palsies as a presenting feature of PMSAH and a review of the literature for cranial nerve palsies post-PMSAH. A 60-year-old gentleman was admitted with a sudden onset headache, bilateral oculomotor nerve, and unilateral abducens nerve palsies. CT demonstrated PMSAH, and angiography excluded a structural cause. On longer-term follow-up, he had persistent left-sided oculomotor nerve palsy. To the best of our knowledge, this is the first report of multiple cranial nerve palsies as a presenting feature of PMSAH and demonstrates the possibility of persistent neurological deficit following PMSAH.