True- true- unrelated? A delayed onset, complete third-nerve palsy after traumatic subarachnoid hemorrhage.

UNLABELLED: A 61-year-old male presented to the emergency department (ED) with painless diplopia, left-ptosis, and left downward gaze, 3 days after sustaining a fall from standing height with subsequent lumbar and head trauma. Prior to the ED consult, his only symptom was persistent generalized high intensity headache. On physical examination, no other neurological deficit was found. Computed tomography (CT) scan showed Fisher 4 subarachnoid hemorrhage (SAH). Cerebral angiogram and brain magnetic resonance imaging (MRI) were negative. Screening for possible secondary causes of isolated third-nerve palsy (TNP) were all negative. To our knowledge, this is the first report of a traumatic SAH with delayed onset of an isolated complete TNP as its manifestation.

CONFLICTS OF INTEREST/DISCLOSURES: None pertinent to this research.

AUTHOR JUSTIFICATIONS: All authors have provided original or professional content and were involved in the clinical care of the patient.

LIST OF ABBREVIATIONS: CNcranial nerveDSAdigital subtraction angiogramGCSGlasgow Coma ScalePCOMposterior communicating arterySAHsubarachnoid hemorrhageTNPthird nerve palsytSAHtraumatic SAH.