# “Sentinel Oculomotor Nerve Palsy”: A Harbinger of Subarachnoid Hemorrhage

## TL;DR

A rare case shows that oculomotor nerve palsy can be an early warning sign of subarachnoid hemorrhage, even before typical headaches appear.

## Contribution

This case report introduces isolated oculomotor nerve palsy as a potential sentinel sign of nonaneurysmal subarachnoid hemorrhage.

## Key findings

- A 64-year-old woman developed oculomotor nerve palsy before experiencing nonaneurysmal SAH.
- Isolated oculomotor nerve palsy may serve as an early, atypical warning sign of SAH.
- Atypical headaches can delay diagnosis, making alternative signs like nerve palsy clinically significant.

## Abstract

Subarachnoid hemorrhage (SAH) is a life-threatening condition most commonly caused by aneurysmal rupture. Sentinel headaches, often described as the “worst headache of life” or a “thunderclap headache,” are critical warning signs that may precede SAH. However, atypical headaches can complicate early diagnosis. Oculomotor nerve palsy, though rare, may occur as a complication of both aneurysmal and nonaneurysmal SAH. We report a unique case of a 64-year-old woman who initially presented with atypical headache followed by isolated oculomotor nerve palsy, preceding the onset of a nonaneurysmal SAH. This case highlights isolated oculomotor palsy as a potential unrecognized sentinel sign of SAH.