J Korean Ophthalmol Soc.  2014 Sep;55(9):1406-1411. 10.3341/jkos.2014.55.9.1406.

Internal Carotid Artery Aneurysm Presenting with Unilateral Nasal Hemianopsia

• Kim KN
• Kim CS
• Lee YH
• Lee SB

• KMID: 2217131
• DOI: http://doi.org/10.3341/jkos.2014.55.9.1406

Abstract

PURPOSE
To report a case of unilateral nasal hemianopsia caused by a large internal carotid artery aneurysm.
CASE SUMMARY
A 56-year-old female presented with large cupping in the left optic nerve head detected incidentally during a routine check-up. She had no underlying systemic disease except hypertension. The best corrected visual acuity was 20/20 in both eyes and a slit-lamp examination showed no abnormal findings. Ophthalmoscopy showed cup/disc ratios of 0.6 in the right eye and 0.75 in the left eye. Relative afferent papillary defect or color vision defect was not observed. A Humphrey visual-field test indicated unilateral nasal hemianopsia in the left eye. Brain CT and angiography revealed a large 2.2-cm aneurysm on the left internal carotid artery.
CONCLUSIONS
Internal carotid artery aneurysm should be considered as a possible cause of unilateral nasal hemianopsia in patients without intraocular lesion.

Keyword

Glaucoma suspect; Internal carotid artery aneurysm; Optic disc cupping; Relative afferent pupillary defect; Unilateral nasal hemianopsia

MeSH Terms

Aneurysm*
Angiography
Brain
Carotid Artery, Internal*
Color Vision Defects
Female
Hemianopsia*
Humans
Hypertension
Middle Aged
Ophthalmoscopy
Optic Disk
Visual Acuity

Figure

• 

  Figure 1. Fundus photographs show cup/disc ratios of 0.6 in the right eye (A) and 0.75 in the left eye (B).

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  Figure 2. Humphrey visual field test demonstrating normal visual field in the right eye (A) and nasal hemianopsia on pattern-deviation plot in the left eye (B).

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  Figure 3. Optical coherence tomography demonstrating a slight but significant superotemporal and inferotemporal retinal nerve fiber layer thinning in the left eye relative to the right eye. ONH = optic nerve head; RNFL = retinal nerve fiber layer; OD = right; OS = left; C/D = cup/disc ratio; TEMP (T) = temporal; SUP (S) = superior; NAS (N) = nasal; INF (I) = inferior.

• 

  Figure 4. Brain CT images of axial section (A) and coronal section (B) shows 2.2-cm large aneurysm on the left internal carotid artery (black arrow) compressing the lateral aspect of the left optic nerve in front of the optic chiasm. Brain CT angiography (C) demonstrates large aneurysm located on the paraclinoid portion of the left internal carotid artery (white arrow).

Reference

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