The Ophthalmologic Symptom as a Clue to Intracerebral Aneurysm
Krüger H.1, Orth H. J.1, Neußer A.1, Harders A.2, Gronemeyer U.1
1Dept. of Ophthalmology; 2Dept. of Neurosurgery, der Ruhr University, Bochum
Purpose: The incidence of aneurysms of the internal carotid artery varies from 0.2 to 9 per cent. Due to variant symptomatology, differential diagnosis is difficult. In order to avoid atrophy due to pressure and neurologic deficiency by an aneurysm, rapid and targeted diagnostic is essential.
Method: Three cases a) optic atrophy; b) oculomotor paresis; c) masked oculomotor paresis are reported. The diagnostic pathway leading to surgical intervention is demonstrated by images and video clips.
Results: All patients underwent successful aneurysm clipping leading to remission to the greatest possible extent. Efficient diagnostic and close interdisciplinary cooperation was essential.
Conclusions: If ophthalmologic examination leads to a presumptive diagnosis of cerebral disorders, stepwise diagnostic procedures must be performed:
1.) Thin slab magnetic resonance imaging (MRI). If not available, thin slice computer tomography (CT);
2.) CT angiography;
3.) Digital subtraction angiography (DSA).
Despite the specific risk of DSA in some cases, this method is the only way to confirm the presence of intracranial aneurysms.
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