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

Abstract

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