J Korean Ophthalmol Soc.  2012 Mar;53(3):486-491.

A Case of Intracavernous Carotid Aneurysm Presenting with Visual Loss with No Oculomotor Disturbance

• Kim SH
• Kim SW
• Kim BT
• Chang JH

Abstract

PURPOSE
Oculomotor disturbance is the common manifestation of intracavernous carotid aneurysm cases. Intracavernous carotid aneurysms causing compressive optic neuropathy with no oculomotor disturbance are relatively rare due to their anatomical characteristics. We experienced a case of intracavernous carotid aneurysm which resulted in a shifted supraclinoid segment of the internal carotid artery, presenting with visual loss and visual field defect with no oculomotor disturbance.
CASE SUMMARY
A 40-year-old woman presented with loss of vision in the right eye. A relative afferent pupillary defect was observed in this eye. Visual field test showed quadranopsia in the right eye. Magnetic resonance imaging revealed that the intracavernous carotid aneurysm had shifted the supraclinoid segment of the internal carotid artery to the superomedial position. The right optic nerve was directly molded by the shifted supraclinoid segment of the internal carotid artery at the point of the bifurcation between the anterior cerebral artery and the middle cerebral artery. A Guglielmi detachable coil (GDC) embolization was performed successfully with no operational complications. Six months after coiling, best corrected visual acuity of the right eye was 1.0, and the visual field defect had recovered in all except the superior temporal field.
CONCLUSIONS
Oculomotor disturbance is frequently associated with intracavernous carotid aneurysms. Nevertheless, optic neuropathy without oculomotor disturbance may be the only sign in patients with an intracavernous carotid aneurysm that causes shifting of the supraclinoid segment of the internal carotid artery.

Keyword

Cavernous sinus; Internal carotid artery aneurysm; Intracavernous carotid aneurysm; Optic neuropathy; Visual dysfunctions

MeSH Terms

Adult
Aneurysm
Anterior Cerebral Artery
Carotid Artery, Internal
Cavernous Sinus
Eye
Female
Fungi
Humans
Magnetic Resonance Imaging
Middle Cerebral Artery
Optic Nerve
Optic Nerve Diseases
Pupil Disorders
Vision, Ocular
Visual Acuity
Visual Field Tests
Visual Fields

Figure

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  Figure 1 Fundus photographs of the case. The neural rim of the temporal area in the right optic disc appears pale.

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  Figure 2 Initial average and quadrant retinal nerve fiber layer (RNFL) thickness as measured by spectral domain optical coherence tomography. RNFL is thinner in the affected eye compared with the unaffected eye. No significant change is observed after 6 months of GDC coiling treatment.

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  Figure 3 T2-weighted axial (left) and coronal (right) magnetic resonance image. Internal carotid artery aneurysm from its intracavernous segment (A) shifted the supraclinoid segment of the internal carotid artery (B) and basal cistern (C). The right optic nerve (D) is molded by the shifted supraclinoid segment of the internal carotid artery directly on the point of the bifurcation between the middle cerebral artery (E) and the anterior cerebral artery (F).

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  Figure 4 Initial Humphrey visual field test (central 30-2 threshold) shows three quadranopsia in the right eye (A). Subsequent perimetries 6 months after GDC coiling demonstrated improvement of visual field (B). Nevethless the visual field of the right eye at 6 months after coiling still has remnant quadranopsia.

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