Acute Retrobulbar Optic Neuropathy as the Sole Manifestation of Subarachnoid Haemorrhage from a Ruptured Anterior Communicating Artery Aneurysm

Abstract

Anterior communicating artery aneurysm is the most common form of intracranial aneurysm and subarachnoid haemorrhage (SAH) is the common presenting feature of anterior communicating artery aneurysms. In general, patients with SAH from anterior communicating artery aneurysm present with neurological deficit. We report an interesting case of a 60-year-old man who presented with acute monocular vision loss accompanied by periorbital pain without any neurological deficit, finally diagnosed with SAH from ruptured anterior communicating artery aneurysm. Five months after immediate craniotomy with aneurysm neck clipping, his visual acuity was improved to 20/63 with a pale optic disc appearance. Acute retrobulbar optic neuropathy may be the sole manifestation of SAH from ruptured anterior communicating artery aneurysm. Unilateral decrease of visual acuity with periorbital pain, in the absence of other neurological change, may be the initial and isolated sign.

The prevalence of microcystic macular changes on optical coherence tomography of the macular region in optic nerve atrophy of non-neuritis origin: a prospective study

“…Therefore, the bilateral optic atrophy was thought to be due to increased intracranial pressure and papilledema. We do not know about other possible complications associated with a poor grade SAH 18. The horizontal OCT cross section through the macular area shows microcystic cysts on both sides of the fovea.…”

“…From a clinical practice point of view, it is relevant that microcystic macular changes are slightly more frequent with compressive aetiologies compared with the 4.7–6.3% reported with a recent episode of MSON 18. The literature on other conditions is only emerging, but it might be prudent to consider neuroimaging if metabolic and hereditary conditions have been excluded and there is no other obvious ophthalmological explanation 11 14 15…”