Neuroophthalmologic Findings of Intracranial Aneurysm

Jun, B Y; Lee, K S; Lee, K C

Abstract

Authors analyzed 40 patients diagnosed as and treated for aneurysmal subarachnoid hemorrhage or unruptured aneurysm at the Yonsei University Hospital from July 1 to September 30, 1986, prospectively. Result of the analysis is summarized as follows ; 1) Ocular motor palsy or gaze palsy was found in 19 patients(47.5% of the total). Thirteen patients had ocular - motor palsy ; 6 oculomotor nerve palsy, 5 abducens nerve palsy, 2 oculomotor and abducens palsy. Six patients had gaze palsy ; 3 impaired conjugation, 2 upward gaze limitation, and 1 conjugated deviation. 2) Most of oculomotor palsies were resulted from direct pressure of IC-Pcom aneurysm on the oculomotor nerve. One incomplete oculomotor palsy might be caused by cerebral vasospasm. Oculomotor nerve palsy recovered in following order ; ptosis, limitation of ocular movements, impairment of pupillary construction. 3) Abducens nerve palsy could be explained by raised intracranial pressure. Vasospasm was also speculated as a possible cause of abducens palsy when other cause were excluded. 4) Incidence of clinical vasospasm increased in proportion to amount of sudarachnoid hemorrhage in the basal cisterns detected on CT scans. 5) Gaze palsy may indicate a grave prognosis, because five out of six patients with gaze palsy eventually died. Impaired conjugation was thought to be resulted from brain stem ischemia, secondary to raised intracranial pressure or vasospasm. Hydrocephalus caused upward gaze limitation, while frontal lobe hematoma produced conjugated deviation. 6) Abnormal ophthalmoscopic findings were found in 15 patients(37.5% of the total). Ten had retinal hemorrhage and five had papilledema.