J Korean Ophthalmol Soc JKOS Journal of the Korean Ophthalmological Society 0378-6471 2092-9374 The Korean Ophthalmological Society 10.3341/jkos.2017.58.11.1276 Original Article The Neuro-ophthalmic Presentation of Intracranial Aneurysms Yoon Han Gyul MD Kim Dae Hyun MD PhD Department of Ophthalmology, Chosun University School of Medicine, Gwangju, Korea. Address reprint requests to Dae Hyun Kim, MD, PhD. Department of Ophthalmology, Chosun University Hospital, #365 Pilmun-daero, Dong-gu, Gwangju 61453, Korea. Tel: 82-62-220-3190, Fax: 82-62-225-9839, eyelovehyun@hanmail.net 11 2017 15 11 2017 58 11 1276 1281 20 07 2017 01 09 2017 16 10 2017 ©2017 The Korean Ophthalmological Society 2017 The Korean Ophthalmological Society This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Purpose

To investigate the neuro-ophthalmic diagnosis and clinical manifestations of intracranial aneurysm.

 Methods

A retrospective survey of 33 patients who were diagnosed with intracranial aneurysm and underwent neuro-ophthalmic examination from April 2008 to December 2016. Frequency of the first diagnosis of intracranial aneurysm in ophthalmology, neuro-ophthalmic diagnosis, location of intracranial aneurysm, examination of intracranial aneurysm rupture, and neurologic prognosis of Terson's syndrome patients were analyzed by image examination, neurosurgery, and ophthalmology chart review.

 Results

Of the 33 patients, most patients (n = 31, 94%) were diagnosed with intracranial aneurysm at the neurosurgical department and only 2 patients were diagnosed initially at the ophthalmology department. Causes and association were: Terson's syndrome (n = 10, 30%), third cranial nerve palsy (n = 10, 30%), internclear ophthalmoplegia (n = 4, 12%), visual field defect (n = 3, 9%), optic atrophy (n = 3, 9%), sixth cranial nerve palsy (n = 2, 6%), and nystagmus (n = 1, 3%). The location of intracranial aneurysms were: anterior communicating artery (n = 13, 39%), medial communicating artery (n = 12, 36%), and posterior communicating artery (n = 5, 15%). Ten of 33 patients had Terson's syndrome, and 6 patients (60%) with Terson's syndrome had apermanent neurological disorder such as agnosia, gait disorder and conduct disorder.

 Conclusions

Third cranial nerve palsy was the most common neuro-ophthalmic disease in patients presenting with intracranial aneurysm. The neuro-ophthalmic prognoses for those diseases were relatively good, but, if Terson's syndrome was present, neurological disorders (agnosia, gait disorder, conduct disorder) were more likely to remain after treatment.

 Intracranial aneurysm Terson's syndrome Third cranial nerve palsy Neuro-ophthalmology Chosun University Hospital

This study was supported by research funds from Chosun University Hospital 2017.

The authors have no conflicts to disclose.

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A com = anterior communicating artery; Basilar tip = bifurcation of basilar tip artery; MCA = medial communicating artery; P com = posterior communicating artery; AN = aneurysm; OPH = ophthalmology.

*Kruskal-Wallis test.

 Classification by the location of intracranial aneurysm

INO = internuclear ophthalmoplegia; VF defect = visual field defect; A com = anterior communicating artery; Basilar tip = bifurcation of basilar tip artery; MCA = medial communicating artery; P com = posterior communicating artery.

 The analysis of Terson's syndrome patients

BCVA = best corrected visual acuity; M = male; F = female; A com = anterior communicating artery; ICH = intracranial hemorrhage; IVH = intraventricular hemorrhage; OD = oculus dexter; HM = hand motion; SAH = subarchnoid hemorrhage; MCA = medial communicating artery; Rt. = right; OS = oculus sinister; OU = oculus uterque; Lt. = left.

 The neurological disability rate of Terson's syndrome patients

Neurologic disability: Agnosia, Gait disorder, Conduct disorder.

*Fisher exact test.