Glyxambi
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 
  • Users Online: 2976
  • Home
  • Print this page
  • Email this page


 
   Table of Contents      
CASE REPORT
Year : 1991  |  Volume : 39  |  Issue : 1  |  Page : 28-29

Giant aneurysm of internal carotid artery presenting features of retrobulbar neuritis


Department of Neurosurg and Ophthalmology, SCB Medical College Hospital, Cuttack, Orissa

Correspondence Address:
Madhumati Misra
Department of Neurosurg and Ophthalmology, SCB Medical College Hospital, Cuttack, Orissa

Login to access the Email id

Source of Support: None, Conflict of Interest: None


PMID: 1894342

Rights and PermissionsRights and Permissions
  Abstract 

We report the case of a man who presented with in the features of left optic nerve compression. CT scan and carotid angiography demonstrated an unruptured giant aneurysm of the left internal carotid artery possibly kinking the optic nerve. Carotid ligation in the neck saved both life and vision.


How to cite this article:
Misra M, Mohanty AB, Rath S. Giant aneurysm of internal carotid artery presenting features of retrobulbar neuritis. Indian J Ophthalmol 1991;39:28-9

How to cite this URL:
Misra M, Mohanty AB, Rath S. Giant aneurysm of internal carotid artery presenting features of retrobulbar neuritis. Indian J Ophthalmol [serial online] 1991 [cited 2019 Sep 23];39:28-9. Available from: http://www.ijo.in/text.asp?1991/39/1/28/24486


  Introduction Top


Aneurysms of the internal carotid artery are usually detected after the first subarachnoid haemorrhage as­sociated with cranial nerve signs [1],[2],[3],[4]. Such aneurysms in the anterior cavernous sinus involve the third nerve alone or all the oculomotor nerves may be involved [3],[4],[5],[6],[7].However an aneurysm of the internal carotid artery presenting with features of ipsilateral optic nerve com­pression without oculomotor involvement is extremely rare.

We report the case of a young man who had an asymptomatic left internal carotid artery aneurysm. Sud­den expansion of the aneurysm sac caused kinking of the ipsilateral optic nerve and simulated features of retrobulbar neuritis. The nature of such an aneurysmal growth is still unknown and seems to be due to two factors; real enlargement of the sac and thinning of the wall from episodes of clinically unknown bleeding [3],[4],[5],[6].. The diagnostic difficulties encountered in this patient due to a typical presenting symptoms and the timely surgery that saved life and vision prompted this case report.


  Report Top


BM, a forty year old man noted sudden loss of vision in his left eye to perception of light only and consulted an ophthalmologist. His right eye was clinically and func­tionally normal The fundi appeared normal in either eye. A clinical diagnosis of left retrobulbar neuritis was thought of and vision in the left eye improved to 6/18 within 15 days following steroid therapy.

The patient reported 3 months later for progressive visual failure on the left side. He had no systemic or neurological deficit. The left eye was proptosed with 2/60 vision and primary optic atrophy [Figure - 1]. The ocular movements were full in both eyes right eye was func­tionally normal. Routine laboratory tests for blood and urine were normal, computed tomographic scan (CT scan) showed a high dense parasellar mass lesion on the left side [Figure - 2] and carotid angiography showed a giant aneurysm of the left internal carotid artery [Figure - 3]. right carotid angiography showed adequate collateral circulation to the opposite hemisphere. Left internal carotid artery ligation in the neck was performed after Mats' compression test. The patient when last seen two years after surgery was asymptomatic and his vision in the left eye has improved to 6/24 and proptosis decreased.


  Discussion Top


Lesions in the retro-orbital, parasellar and cavernous sinus regions involve the ocular nerves and vessels in their intracranial course in various combinations and may present confusing clinical signs. [6]

Giant aneurysm of the internal carotid artery in the anterior cavernous sinus involve the third nerve alone or other oculomotor nerves may be involved. Encroach­ment on the middle and posterior cavernous sinus is indicated by involvement of the V1 and V2 sensory roots, papilloedema and proptosis [3],[7],[9] An intracavernous aneurysm presenting with features of intermittent optic nerve compression without oculomotor involvement as in the present case is extremely rare. The evolution of such changes have been fully documented by Misra and Rath (1985). Sudden visual loss in the left eye followed by partial recovery suggest acute expansion of the pre­existing asymptomatic aneurysm kinking the optic nerve, such aneurysmal enlargement occurs due to thinning of its wall from episodes of bleeding. [6]

On CT scan, non thrombosed aneurysms appear sharp­ly delineated with homogenous density and a throm­bosed aneurysm may have a calcified wall [10]. However, carotid angiography continues to play an important role in the diagnosis of aneurysms [6] Cervical carotid ligation with or without a bypass procedure remain a safe and valid treatment for these patients although good results can be obtained by direct microsurgical approach [6],[9]

It seems that our case of unruptured giant aneurysm of the internal carotid artery presenting features of retrobulbar neuritis due to optic nerve compression is extremely rare and review of literature failed to show a similar case. The purpose of this report is to alert oph­thalmologists to certain pit-falls in the diagnosis of retrobulbar neuritis and unilateral optic atrophy.

 
  References Top

1.
Pick J. Lim DP, Bock WJ-Surg. Neurology. 20. 288, 1983.  Back to cited text no. 1
    
2.
Borr H.W.K., Black "'ood W - Brain 94. 607.1971.  Back to cited text no. 2
    
3.
Mancuse AA, Hansfee W.N. Winter J. Neuroradiology. 16.449.1978.   Back to cited text no. 3
    
4.
Rath S. Misra. M. Ind. J. Ophthalmol. 30.157.1982.   Back to cited text no. 4
    
5.
RAth S. Misra. M. Neurology India. 32.53. 1984.   Back to cited text no. 5
    
6.
Misra M. Rath S Ind. ,l. Ophthalmol. 33.327. 1985.  Back to cited text no. 6
    
7.
Pozzati E. Fagioti L., Servadel F. Gaist G - J. Neurol. Surg. 55. 527. 1981.   Back to cited text no. 7
    
8.
RAymond DA. Tew J- J. Neuro Surg. Psychat. 41.83. 1975.   Back to cited text no. 8
    
9.
Galber BR. Sundt Tm- J. Neuro Surg. 52.1.1980.   Back to cited text no. 9
    
10.
Schubiger A. Valavanis A. Hayek J.J. Comput. Assit-Tomogr. 2.24.1980.  Back to cited text no. 10
    


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Abstract
Introduction
Report
Discussion
References
Article Figures

 Article Access Statistics
    Viewed4076    
    Printed96    
    Emailed2    
    PDF Downloaded0    
    Comments [Add]    

Recommend this journal