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KMID : 0360220170580111276
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Journal of the Korean Ophthalmological Society
2017 Volume.58 No. 11 p.1276 ~ p.1281
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The Neuro-ophthalmic Presentation of Intracranial Aneurysms
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Yoon Han-Gyul
Kim Dae-Hyun
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Abstract
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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 a permanent 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.
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KEYWORD
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Intracranial aneurysm, Terson’s syndrome, Third cranial nerve palsy, Neuro-ophthalmology
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