Internal Carotid Artery Aneurysm Presenting with Unilateral Nasal Hemianopsia

Kyoung Nam Kim; Chang Sik Kim; Yeon Hee Lee; Sung Bok Lee

doi:10.3341/jkos.2014.55.9.1406

Journal List > J Korean Ophthalmol Soc > v.55(9) > 1009796

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Kim, Kim, Lee, and Lee: Internal Carotid Artery Aneurysm Presenting with Unilateral Nasal Hemianopsia

Case Report

J Korean Ophthalmol Soc 2014;55(9):1406-1411.

Published online: 2 September 2014

DOI: https://doi.org/10.3341/jkos.2014.55.9.1406

Internal Carotid Artery Aneurysm Presenting with Unilateral Nasal Hemianopsia

Kyoung Nam Kim, MD, Chang Sik Kim, MD, PhD, Yeon Hee Lee, MD, PhD, Sung Bok Lee, MD, PhD

Department of Ophthalmology, Chungnam National University School of Medicine, Daejeon, Korea

Address reprint requests to Sung Bok Lee, MD, PhD, Department of Ophthalmology, Chungnam National University Hospital, #282 Munhwa-ro, Jung-gu, Daejeon 301-721, Korea, Tel: 82-42-280-7604, Fax: 82-42-255-3745, E-mail: sblee@cnu.ac.kr

Received 21 March 2014 Revised 19 May 2014 Accepted 17 July 2014

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.

Abstract

Purpose

To report a case of unilateral nasal hemianopsia caused by a large internal carotid artery aneurysm.

Case summary

A 56-year-old female presented with large cupping in the left optic nerve head detected incidentally during a routine check-up. She had no underlying systemic disease except hypertension. The best corrected visual acuity was 20/20 in both eyes and a slit-lamp examination showed no abnormal findings. Ophthalmoscopy showed cup/disc ratios of 0.6 in the right eye and 0.75 in the left eye. Relative afferent papillary defect or color vision defect was not observed. A Humphrey visual-field test indicated unilateral nasal hemianopsia in the left eye. Brain CT and angiography revealed a large 2.2-cm aneurysm on the left internal carotid artery.

Conclusions

Internal carotid artery aneurysm should be considered as a possible cause of unilateral nasal hemianopsia in patients without intraocular lesion.

Keywords: Glaucoma suspect, Internal carotid artery aneurysm, Optic disc cupping, Relative afferent pupillary defect, Unilateral nasal hemianopsia

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Figure 1.

Fundus photographs show cup/disc ratios of 0.6 in the right eye (A) and 0.75 in the left eye (B).

Figure 2.

Humphrey visual field test demonstrating normal visual field in the right eye (A) and nasal hemianopsia on pattern-deviation plot in the left eye (B).

Figure 3.

Optical coherence tomography demonstrating a slight but significant superotemporal and inferotemporal retinal nerve fiber layer thinning in the left eye relative to the right eye. ONH = optic nerve head; RNFL = retinal nerve fiber layer; OD = right; OS = left; C/D = cup/disc ratio; TEMP (T) = temporal; SUP (S) = superior; NAS (N) = nasal; INF (I) = inferior.

Figure 4.

Brain CT images of axial section (A) and coronal section (B) shows 2.2-cm large aneurysm on the left internal carotid artery (black arrow) compressing the lateral aspect of the left optic nerve in front of the optic chiasm. Brain CT angiography (C) demonstrates large aneurysm located on the paraclinoid portion of the left internal carotid artery (white arrow).

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