Open Access

Intracranial internal carotid aneurysm causing diplopia

International Journal of Emergency Medicine20114:56

https://doi.org/10.1186/1865-1380-4-56

Received: 13 December 2010

Accepted: 2 September 2011

Published: 2 September 2011

Abstract

Internal carotid intracranial aneurysms are a relatively rare form of intracranial aneurysm that presents with diplopia, retro-orbital pain and unilateral headaches. The symptoms are progressive and the diagnosis should be considered in a patient presenting with these complaints. Underlying hypertension and advanced age are specific risk factors.

Case Report

A 73-year-old diabetic male presented with progressively worsening diplopia and difficulty reading for 2 months. He denied having any fever, trauma, headache, numbness or weakness of his extremities or changes in other senses. Vital signs, physical and neurological exams were unremarkable, except for diplopia on right lateral gaze with distance, but not on left lateral gaze. CT, CTA, and MRI of the brain were obtained in addition to a cerebral angiogram (Figures 1, 2, 3, 4 and 5).
Figure 1

CT without contrast demonstrates a soft tissue attenuation mass filling the sella with adjacent bone remodeling (arrow).

Figure 2

On the post contrast images, there is a 1.8 × 2.9 × 1.6 cm (AP × transverse × craniocaudad) aneurysm with incomplete wall calcification originating from cavernous portion of the left internal carotid artery.

Figure 3

On the post contrast images, there is a 1.8 × 2.9 × 1.6 cm (AP × transverse × craniocaudad) aneurysm with incomplete wall calcification originating from cavernous portion of the left internal carotid artery.

Figure 4

Findings are confirmed by cerebral angiography and colorized.

Figure 5

Findings are confirmed by cerebral angiography and colorized.

Internal carotid aneurysms located in the intracavernous region account for 3-5% of all intracranial aneurysms [1]. Systemic hypertension is a primary risk factor for development of aneurysm. Life-threatening risk or permanent neurological complications of most carotid cavernous aneurysms (CAA) are relatively low [2]. Despite this, ophthalmic morbidity is a leading consideration for treatment [3]. Diplopia (65% of cases), retro-orbital pain, and unilateral headache are the most common symptoms at presentation of CAA, followed by CN III and CN VI paresis [4]. The mainstay of symptomatic CAA has moved away from surgical and endovascular balloon techniques in favor of endovascular stenting and coiling approaches [4].

Consent

Patient consent was obtained and the case report qualified for IRB exemption given the lack of specific identifiable patient information within the case report and clinical images.

Declarations

Authors’ Affiliations

(1)
Department of Emergency Medicine, SUNY Upstate Medical University
(2)
SUNY Upstate Medical University
(3)
Department of Radiology, SUNY Upstate Medical University

References

  1. Bars HW, Blackwood W, Meadows SP: Intracavernous carotid aneurysms. A clinical-pathological report. Brain 1971, 94: 607–622. 10.1093/brain/94.4.607View ArticleGoogle Scholar
  2. Kupersmith MJ, Hurst R, Berenstein A, Choi IS, Jafar J, Ransohoff J: The benign course of cavernous carotid artery aneurysms. J Neurosurg 1992, 77: 690–693. 10.3171/jns.1992.77.5.0690View ArticlePubMedGoogle Scholar
  3. Johnston SC, Wilson CB, Halbach VV, Higashida RT, Dowd CF, McDermott MW, Applebury CB, Farley TL, Gress DR: Endovascular and surgical treatment of unruptured cerebral aneurysms: Comparison of risks. Ann Neurol 2000, 48: 11–19. 10.1002/1531-8249(200007)48:1<11::AID-ANA4>3.0.CO;2-VView ArticlePubMedGoogle Scholar
  4. Stiebel-Kalish H, Kalish Y, Bar-On RH, Setton A, Niimi Y, Berenstein A, Kupersmith MJ: Presentation, natural history, and management of carotid cavernous aneurysms. Neurosurgery 2005, 57(5):850–7. discussion 850–7 10.1227/01.NEU.0000179922.48165.42View ArticlePubMedGoogle Scholar

Copyright

© Kloss et al; licensee Springer. 2011

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Advertisement