Anterior Communicating Artery Aneurysm Related to Visual Symptoms

Park, Jung Hyun; Park, Sang Keun; Kim, Tae Hong; Shin, Jae‐Gook; Shin, Hyung Shik; Hwang, Yong Soon

doi:10.3340/jkns.2009.46.3.232

Cited by 30 publications

(47 citation statements)

References 28 publications

(66 reference statements)

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“…Aneurysm arising from anterior communicating artery can produce visual symptoms according to the direction and size. 1 Patients may complain of vision loss with transient headaches. 3 Other visual symptoms include bitemporal or homonymous hemianopsia due to the compression of the optic chiasm or tract.…”

Section: Discussionmentioning

confidence: 99%

“…3 Other visual symptoms include bitemporal or homonymous hemianopsia due to the compression of the optic chiasm or tract. 1 Ruptured anterior communicating aneurysm with SAH generally is accompanied by focal neurological deficit. 2 Acute retrobulbar optic neuropathy due to anterior communicating artery aneurysm is rare, and there have been a few case reports of acute retrobulbar optic neuropathy related to ruptured anterior communicating artery aneurysm.…”

Section: Discussionmentioning

confidence: 99%

“…2 Since aneurysm of the anterior communicating artery is located closely to the optic nerve, it can also cause visual symptoms by compressing the optic nerve or rupture of aneurysm with focal haematoma formation. 1 We here present an unusual case of a patient confirmed as SAH from a ruptured anterior communicating artery aneurysm, initially manifested as an acute retrobulbar optic neuropathy without any other neurological change.…”

Section: Introductionmentioning

confidence: 99%

“…1 Subarachnoid haemorrhage (SAH) is the common presenting feature of anterior communicating artery aneurysms. 2 In general, patients with SAH from anterior communicating artery aneurysm are presented with neurological deficit.…”

Section: Introductionmentioning

confidence: 99%

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

Lee

Shin

Park

2013

Neuro-Ophthalmology

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Lee

Shin

Park

2013

Neuro-Ophthalmology

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“…An aneurysm is often an incidental finding during investigations for other causes of intracranial pathology. 40 Aneurysms may present in 23,41,42 unilateral third nerve palsy (posterior communicating artery aneurysm), 41 facial or orbital pain, epistaxis, progressive vision loss and/or opthalmoplegia (intercavernous internal carotid artery), 43 and symptoms of brainstem dysfunction (posterior circulation aneurysms). 14 The most common presenting feature of an aneurysm is SAH.…”

Section: Clinical Presentation Assessment Of Severity and Preoperatmentioning

confidence: 99%

Aneurysmal Subarachnoid Hemorrhage

2011

Encyclopedia of Clinical Neuropsychology

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Aneurysmal subarachnoid hemorrhage (SAH) is a worldwide health burden with high fatality and permanent disability rates. The overall prognosis depends on the volume of the initial bleed, rebleeding, and degree of delayed cerebral ischemia (DCI). Cardiac manifestations and neurogenic pulmonary edema indicate the severity of SAH. The International Subarachnoid Aneurysm Trial (ISAT) reported a favorable neurological outcome with the endovascular coiling procedure compared with surgical clipping at the end of 1 year. The ISAT trial recruits were primarily neurologically good grade patients with smaller anterior circulation aneurysms, and therefore the results cannot be reliably extrapolated to larger aneurysms, posterior circulation aneurysms, patients presenting with complex aneurysm morphology, and poor neurological grades. The role of hypothermia is not proven to be neuroprotective according to a large randomized controlled trial, Intraoperative Hypothermia for Aneurysms Surgery Trial (IHAST II), which recruited patients with good neurological grades. Patients in this trial were subjected to slow cooling and inadequate cooling time and were rewarmed rapidly. This methodology would have reduced the beneficial effects of hypothermia. Adenosine is found to be beneficial for transient induced hypotension in 2 retrospective analyses, without increasing the risk for cardiac and neurological morbidity. The neurological benefit of pharmacological neuroprotection and neuromonitoring is not proven in patients undergoing clipping of aneurysms. DCI is an important cause of morbidity and mortality following SAH, and the pathophysiology is likely multifactorial and not yet understood. At present, oral nimodipine has an established role in the management of DCI, along with maintenance of euvolemia and induced hypertension. Following SAH, hypernatremia, although less common than hyponatremia, is a predictor of poor neurological outcome.Key Words: subarachnoid hemorrhage, intracranial aneurysm, delayed cerebral ischemia (J Neurosurg Anesthesiol 2015;27:222-240) SUBARACHNOID HEMORRHAGE (SAH) IS A WORLDWIDE HEALTH BURDEN WITH HIGH RATES OF FATALITY AND PERMANENT DISABILITYThe estimated worldwide incidence of SAH is 9/ 100,000 persons/y with regional variation. 1 One systematic review found the incidence to be lower in South and Central America (4.2/100,000 persons/y) and higher in Japan (22.7/100,000 persons/y) and Finland (19.7/100,000 persons/y). 1 Interestingly, the prevalence of intracranial aneurysm is not found to be higher in Japan or Finland, 2 but the risk for rupture is higher. 3 The incidence is also reported lower in China (2.0 //100,000 persons/y). 4 SAH accounts for only 5% of all strokes, 5 but it has high mortality and permanent disability rates. A retrospective cohort study in 2 large Norwegian populations between 1984 and 2007 reported a 30-day case fatality rate of 36%. 6 A nationwide Danish study reported a similar 30-day mortality at 38%. 7 World Health Organization Multinational Monitoring Trends...

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