J Korean Ophthalmol Soc.  2012 Sep;53(9):1368-1371. 10.3341/jkos.2012.53.9.1368.

A Giant Unruptured Aneurysm of Distal Internal Carotid Artery Presenting with Compressive Optic Neuropathy

• Park JY
• Koo NK

• KMID: 2216095
• DOI: http://doi.org/10.3341/jkos.2012.53.9.1368

Abstract

PURPOSE
To report a case of compressive optic neuropathy due to a giant unruptured aneurysm of a distal internal carotid artery.
CASE SUMMARY
A 68-year-old female presented with a one-week history of visual disturbance in her left eye. The patient had no underlying disease except hypertension. Best corrected visual acuity was 20/20 in the right eye and 8/20 in the left eye. The color perception test showed abnormal findings in the left eye. Slit lamp examination showed no abnormal finding except incipient cataract in both eyes. Additionally, fundus examination showed no abnormal finding. Brain MRI and MRA revealed a 2.4 x 2.2 x 3.0-cm-sized unruptured giant aneurysm on the left internal carotid artery.
CONCLUSIONS
A giant aneurysm should be considered as a cause for acute or subacute optic neuropathy in a patient with hypertension.

Keyword

Compressive optic neuropathy; Giant aneurysm

MeSH Terms

Aged
Aneurysm
Brain
Carotid Artery, Internal
Cataract
Color Perception Tests
Eye
Female
Humans
Hypertension
Optic Nerve Diseases
Visual Acuity

Figure

• 

  Figure 1 Fundus photographs show no abnormal findings in both eyes.

• 

  Figure 2 Humphrey visual field test of both eyes. (A) Right eye shows inferotemporal visual field defect on pattern deviation. (B) Left eye shows constricted peripheral visual field on pattern deviation.

• 

  Figure 3 MR image of both horizontal section and coronal section. (A) MR images shows abnormal signal on horizontal section (arrow). (B) MR images shows abnormal signal compressing the optic chiasm (arrow) on coronal section.

• 

  Figure 4 MR angiogram showing 2.4 × 2.2 × 3.0 cm sized giant intracranial aneurysm of left internal carotid artery (arrow).

Reference

1. Artmann H, Vonofakos D, Müller H, Grau H. Neuroradiologic and neuropathologic findings with growing giant intracranial aneurysm. Review of the literature. Surg Neurol. 1984. 21:391–401.

2. Horowitz MB, Yonas H, Jungreis C, Hung TK. Management of a giant middle cerebral artery fusiform serpentine aneurysm with distal clip application and retrograde thrombosis: case report and review of the literature. Surg Neurol. 1994. 41:221–225.

3. Sonntag VK, Yuan RH, Stein BM. Giant intracranial aneurysms: a review of 13 cases. Surg Neurol. 1977. 8:81–84.

4. Kim JY, Choi HY. A case of the giant aneurysm in the distal portion of the posterior cerebral artery: A case report. J Korean Neurosurg Soc. 2000. 29:963–967.

5. Sundt TM Jr, Piepgras DG. Surgical approach to giant intracranial aneurysms. Operative experience with 80 cases. J Neurosurg. 1979. 51:731–742.

6. Ellamushi H, Thorne L, Kitchen N. Unruptured cerebral aneurysms causing seizure disorder (report of two cases). Seizure. 1999. 8:310–312.

7. Heros RC, Kolluri S. Giant intracranial aneurysms presenting with massive cerebral edema. Neurosurgery. 1984. 15:572–577.

8. Whittle IR, Dorsch NW, Besser M. Giant intracranial aneurysms: diagnosis, management, and outcome. Surg Neurol. 1984. 21:218–230.

9. Fried LC, Yballe A. Rapid formation of giant aneurysms: case report. J Neurol Neurosurg Psychiatry. 1972. 35:527–530.

10. Koshikawa N, Kamio M, Sekino H, et al. [Giant aneurysm--a case report with review of literature (author's transl)]. No Shinkei Geka. 1980. 8:79–88.