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Context: Unilateral Abducens Nerve Palsy (ANP) caused by ruptured Anterior Communicating Artery (ACoA) aneurysm has been rarely reported. Most of the ANP reports due to spontaneous subarachnoid hemorrhage (SAH) are bilateral paralysis. Facilitate Cerebrospinal Circulation (CSF) through microsurgery could help to solve this neurological deficit after SAH. Case Report: A patient was admitted on emergency department with sudden onset of headache, vomiting and left unilateral sixth nerve palsy. Computed tomography angiography revealed cisternal SAH and a 4 mm saccular aneurysm on anterior communicating artery. The patient underwent surgical aneurysm clipping with concomitant lamina terminalis and Lilliequist’s membrane fenestration. Few days after the procedure she evolved with complete ANP regression and received discharge without neurological deficits. Conclusions: Microsurgical lamina terminalis and Lilliequist’s membrane fenestration performed concomitant to the surgery for aneurysm clipping may be a factor, which contributes to more rapid clinical improvement in patients who develop ANP after SAH.

Unilateral sixth nerve palsy due to spontaneous subarachnoid hemorrhage