J Korean Ophthalmol Soc.  2017 Nov;58(11):1276-1281. 10.3341/jkos.2017.58.11.1276.

The Neuro-ophthalmic Presentation of Intracranial Aneurysms

• Yoon HG
• Kim DH

• KMID: 2395870
• DOI: http://doi.org/10.3341/jkos.2017.58.11.1276

Abstract

PURPOSE
To investigate the neuro-ophthalmic diagnosis and clinical manifestations of intracranial aneurysm.
METHODS
A retrospective survey of 33 patients who were diagnosed with intracranial aneurysm and underwent neuro-ophthalmic examination from April 2008 to December 2016. Frequency of the first diagnosis of intracranial aneurysm in ophthalmology, neuro-ophthalmic diagnosis, location of intracranial aneurysm, examination of intracranial aneurysm rupture, and neurologic prognosis of Terson's syndrome patients were analyzed by image examination, neurosurgery, and ophthalmology chart review.
RESULTS
Of the 33 patients, most patients (n = 31, 94%) were diagnosed with intracranial aneurysm at the neurosurgical department and only 2 patients were diagnosed initially at the ophthalmology department. Causes and association were: Terson's syndrome (n = 10, 30%), third cranial nerve palsy (n = 10, 30%), internclear ophthalmoplegia (n = 4, 12%), visual field defect (n = 3, 9%), optic atrophy (n = 3, 9%), sixth cranial nerve palsy (n = 2, 6%), and nystagmus (n = 1, 3%). The location of intracranial aneurysms were: anterior communicating artery (n = 13, 39%), medial communicating artery (n = 12, 36%), and posterior communicating artery (n = 5, 15%). Ten of 33 patients had Terson's syndrome, and 6 patients (60%) with Terson's syndrome had apermanent neurological disorder such as agnosia, gait disorder and conduct disorder.
CONCLUSIONS
Third cranial nerve palsy was the most common neuro-ophthalmic disease in patients presenting with intracranial aneurysm. The neuro-ophthalmic prognoses for those diseases were relatively good, but, if Terson's syndrome was present, neurological disorders (agnosia, gait disorder, conduct disorder) were more likely to remain after treatment.

Keyword

Intracranial aneurysm; Terson's syndrome; Third cranial nerve palsy; Neuro-ophthalmology

MeSH Terms

Abducens Nerve Diseases
Agnosia
Arteries
Conduct Disorder
Diagnosis
Gait
Humans
Intracranial Aneurysm*
Nervous System Diseases
Neurosurgery
Oculomotor Nerve
Ophthalmology
Ophthalmoplegia
Optic Atrophy
Paralysis
Prognosis
Retrospective Studies
Rupture
Visual Fields

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