RATIONALE: The purpose of this case report is to describe the process of the patient developing abductor nerve paralysis, analyze the causes of this symptom, provide new diagnostic and treatment ideas for patients with spontaneous intraventricular hemorrhage who develop abductor nerve paralysis, and be alert to the occurrence of abductor nerve paralysis in such patients. PATIENT CONCERNS: A 49-year-old man was admitted to our hospital with a spontaneous intraventricular hemorrhage. After performing digital subtraction angiography of the whole brain under local anesthesia, his eyes were limited in abduction, accompanied by hemorrhage and exudation of the optic papilla. Edema is an extremely rare condition. DIAGNOSES: Transient intracranial hypertension was considered after reexamination with computed tomography. INTERVENTIONS: The application of mannitol and the release of cerebrospinal fluid were used to reduce intracranial pressure and provide patient-related symptomatic treatment. OUTCOMES: After 1 month, the patient's eyes had no abduction limitation and showed good activity. LESSONS: Abducens nerve palsy is a common condition. Owing to its complex etiology, a careful and comprehensive examination is necessary. In particular, patients with spontaneous cerebral hemorrhage who undergo digital subtraction angiography should pay more attention to the abducens nerve.