J Cerebrovasc Endovasc Neurosurg.  2017 Jun;19(2):92-95. 10.7461/jcen.2017.19.2.92.

An Unruptured Anterior Communicating Artery Aneurysm Presenting with Left Homonymous Hemianopsia: A Case Report

• Kim JW
• Nam TK
• Park KS
• Park YS
• Kwon JT

• KMID: 2393385
• DOI: http://doi.org/10.7461/jcen.2017.19.2.92

Abstract

Unruptured cerebral aneurysms sometimes present with visual symptomsdue to compression of the visual pathways. However, until now, unruptured anterior communicating artery (ACoA) aneurysms presenting visual field defects have been extremely rare. The authors report the case of a 51-year-old woman who presented with left homonymous hemianopsia. Radiological findings demonstrated an ACoA aneurysm filled with thrombus, that was compressing the optic chiasm and post-chiasmal tract. The patient underwent clipping of the aneurysm, which resolved the visual field defect. In cases of visual field defects, an ACoA aneurysm should be included in the differential diagnosis.

Keyword

Cerebral aneurysm; Visual dysfunction; Anterior communicating artery

MeSH Terms

Aneurysm
Arteries
Diagnosis, Differential
Female
Hemianopsia*
Humans
Intracranial Aneurysm*
Middle Aged
Optic Chiasm
Thrombosis
Visual Fields
Visual Pathways

Figure

• 

  Fig. 1 Preoperative static visual field tests, right eye (A) and left eye (B), showing a left homonymous hemianopsia. Impovement of the visual fields in right eye (C) and left eye (D) at two months after surgery.

• 

  Fig. 2 (A, B) CoronalT2-weighted and T1-weighted with contrast images revealing a thrombosed aneurysm compressing the right side of the optic chiasm and postchiasmatic optic tract. (C) Axial T2-weighted FLAIR image showing the high signal intensity (arrow) of the right post-chiasmal optic tract.

• 

  Fig. 3 Right internal carotid angiography, anteroposterior view (A) and 3D reconstruction (B), showing anterior communicating artery aneurysm projecting posteroinferiorly.

• 

  Fig. 4 Intraoperative photographs obtained before (A) and after (B) aneurysmal neck (arrow) clipping. ON = optic nerve.

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