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A rare case of bilateral abducens nerve paralyses after rupture of an anterior communicating artery (AcoA) aneurysm occurred in a 56-year-old female after sudden onset of severe headache. Bilateral abducens nerve paralyses were present without additional neuro-ophthalmological signs. Computed tomography revealed subarachnoid hemorrhage (SAH). Angiography showed an AcoA aneurysm (15 mm in diameter, directed anteroinferiorly) that was successfully clipped. Postoperatively, the bilateral abducens nerve paralyses gradually recovered and disappeared 3 months after onset. Bilateral abducens nerve paralyses may occur after SAH due to ruptured AcoA aneurysm, and neurosurgeons should be alert to this possibility.
