Eye movement abnormalities after a ruptured intracranial aneurysm.

OBJECTIVE

Overlooking eye movement abnormalities associated with aneurysmal subarachnoid hemorrhage (aSAH) is common, although these abnormalities may greatly affect quality of life. Their prevalence remains undetermined. The aim of the study was to assess preoperative and postoperative eye movement abnormalities and their recovery in follow-up of patients with aSAH and their association with age, gender, and aSAH severity.

METHODS

Patients admitted to Helsinki University Central Hospital who underwent surgery or endovascular treatment for a ruptured intracranial aneurysm during 2011 were participants in this prospective study. A neuro-ophthalmic examination was performed on admission, and 3 days, 14 days, 2-4 months, and 6 months postoperatively. For those patients with third, fourth, or sixth nerve palsies or brainstem vascular syndromes, follow-up was 12 months. Associations between neuro-ophthalmic findings and relevant clinical, radiologic, and demographic data were studied. Two intraoperative videos were selected to show rare cases of aneurysms causing cranial nerve palsies.

RESULTS

Of 121 participants, 11 (9%) presented on admission and 16 (13%) postoperatively showed signs of third, fourth, or sixth nerve palsy. Most of these palsies resolved; leaving 2.5% of all patients presenting with a partial palsy at 1 year. We also evaluated the frequencies of horizontal gaze pareses (n = 9) and Parinaud's syndromes (n = 3). No statistically significant associations emerged between neuro-ophthalmic findings and other clinical variables.

CONCLUSIONS

Eye movement abnormalities are a quite common finding in the acute stage of aSAH. Within 1 year, however, marked improvement occurs. Identifying these neuro-ophthalmic findings can assist in localization of the underlying pathology.