Indian Journal of Ophthalmology

ARTICLES
Year
: 1979  |  Volume : 27  |  Issue : 4  |  Page : 212--213

Aneurysm of intra cavernous carotid artery


Gangadhara Reddy, Raja Reddy, Murali Dhar, Rajyalakshmi 
 S.D. Eye Hospital, Hyderabad, India

Correspondence Address:
Gangadhara Reddy
S.D. Eye Hospital, Hyderabad
India




How to cite this article:
Reddy G, Reddy R, Dhar M, Rajyalakshmi. Aneurysm of intra cavernous carotid artery.Indian J Ophthalmol 1979;27:212-213


How to cite this URL:
Reddy G, Reddy R, Dhar M, Rajyalakshmi. Aneurysm of intra cavernous carotid artery. Indian J Ophthalmol [serial online] 1979 [cited 2020 Jun 3 ];27:212-213
Available from: http://www.ijo.in/text.asp?1979/27/4/212/32634


Full Text

Aneurysms of intracavernous carotid artery are rare and constituted only 1.9% of a large series of intracranial aneurysms reported[2]. These aneurysms present with a characteris­tic clinical picture[1]. Three such cases encountered by us in a period of five years are reported here.

Case Report

Case 1: C.B. 27 years old right handed female was admitted with the complaints of headache and blindness in the right eye of three months duration. On examina­tion the patient was found to be in moderate distress with total right ophthalmoplegia and hypoaesthesia and hypoalgesia involving the distribution of first division of right fifth nerve. General systemic examination was within normal limits.

Skiagrams of skull and chest were normal. Right carotid angiogram showed a fusiform aneurysm of right internal carotid canal and also a sacular aneurysm of the same artery in the cavernous sinus. Multiple aneurysms form about 1/5th of all case of intracranical aneurysms.

Right common carotid artery was ligated under local anaesthesia. There has been general improvement in her signs and symptoms and follow up after one year showed almost complete recovery of eye ball movements.

Case 2: S. M. a sixty year old right handed female presented with total ophthalmoplegia of left eye and also diminished vision in the same eye. She was in a fairly good general health.

A left carotid angiogram revealed a large aneurysm of the internal carotid artery in its cavernous portion. Ligation of the left common carotid artery was per­formed under local anaesthesia. She had an uneventful post-operative period and follow up after six months showed an excellent recovery of the movements of the left eye ball and also of the visual acuity.

Case 3: V.L. a fifty year old right handed female was admitted with the complaints of severe pain behind the left eye, immobility of the left eye ball, and fall of vision. The symptoms evolved over a period of four years. On examination she was found to be hypertensive with a blood pressure of 170/110 mm Hg., with total ophthalmoplegia of left eye, with proptosis, hypoalgesia and hypoaesthesia involving the left half of face, and also deviation of the jaw to the right side. There was also a lower neurone type of left facial palsy.

Plain skiagram of skull revealed erosion of anterior and posterior clinoids and enlargement of sella turcica. Left carotid angiogram showed a giant aneurysm of the left carotid artery in the cavernous sinus.

 Discussion



Giant aneurysms rarely bleed. Tyey present themselves as space ocupying lesions.

Left common carotid artery was ligated under general anaesthesia. At the time of discharge the patient had a remarkable amount of relief from the previously agonising pain.

In India and other far eastern countries there has been relatively lower incidence of intracranial aneurysms compared to western studies[3],[4],[5].

Intracavernous aneurysms seem to be far more common in females. All 3 cases in this series were females. Thirty three of Jefferson's[1] 36 cases were females too.

Angiography clinches the diagnosis but it may not show the entire aneurysm, filling only partially. Treatment consists of ligating the common carotid artery and this was sufficient in most of the cases. Where this is not sufficient further ligation of internal carotid is advisable. Any failure of extracranial procedure may call for trapping of aneurysm or intracranial clipping of the internal carotid artery.

 Summary



Three cases of intracavernous carotid aneurysms have been presented for their rarity.

All were females. One was with a second aneurysm and another with a giant one. All did well on carotid ligation.

References

1Jefferson, G., Selected papers, 1960, Pitman Med. Pub: Co. Ltd., London.
2Locksley, H.B., J. Neurosurg., 25: 219, 1966.
3Raja Reddy, D., Dayananda Rao, B,, Prabbakar, V. and Veera Raghava Reddy, M., 1972. (India) Proceedings, Supplement, 23, Neurology
4Raja Reddy, D., Prabhakar, V. and Dayananda Rao, B., 1972, Neurology (India), 20, 8.
5Ramamurthi, B., 1969, J. Neurology. 30,154.