Atlas of Ophthalmology

Vertical Deviation with Leftsided Trochlearis Paresis and Intermittened Diplopia by Fusiform Aneurysm of the Basilar Artery (9 Gaze Directions)

Vertical Deviation with Leftsided Trochlearis Paresis and Intermittened Diplopia by Fusiform Aneurysm of the Basilar Artery (9 Gaze Directions)
81 years of age, male, BCVA 0.8 at OD, 0.6 at OS Main complaint: diplopia Ocular medical history: uncomplicated cataract surgery at OD in 2009 General medical history: arterial hypertension. Purpose: to present a 81-year-old Caucasian man with a history of arterial hypertension presented to the Department of Ophthalmology complaining of diplopia. He was found to have a large basilar artery aneurysm. Methods: Ophthalmoscopy, neuro-ophthalmological examination, OCT, MRI. Findings: 1) Ophthalmoscopy showed regular retina and optic nerve head. 2) OCT showing generalized thinning of retinal nerve fiber thickness 3) Neuro-ophthalmological examination depicted left sided trochlear nerve paresis with a vertical deviation of 3.5° leading to intermittened diplopia. 4) MRI-Angiography: Imaging of the brain revealed a fusiform aneurysm of the proximal basilar artery with a diameter of 17 mm. Discussion: The visual pathways and the ocular motor cranial nerves are frequently injured by expanding cerebral aneurysms. Neuro-ophthalmologic signs and symptoms may be the only indications of an aneurysm prior to rupture. Acute or chronic visual loss may herald an aneurysm prior to rupture. Diplopia and retro-orbital pain may be warning signs that precede the discovery of a posterior communicating, basilar, or cavernous sinus aneurysm. Dolichoectasia of intracranial arteries is a rare arteriopathy characterized by elongation and widening of the arteries and disturbance of the laminar blood flow. It involves mostly vertebral and basilar arteries. In advanced cases, formation of a fusiform aneurysm is possible. Intracranial arterial dolichoectasia may be asymptomatic for a long time. However, in many cases it leads to neurological symptoms associated with haemodynamic disturbance and mass effect caused by the widened vessel.(1) Literature: (1) Baran B, Kornafel O, Guziński M, Sąsiadek M. Dolichoectasia of the circle of Willis arteries and fusiform aneurysm of basilar artery - case report and review of the literature. Pol J Radiol. 2012 Apr;77(2):54-9.
Dörfler, Arnd, Prof. Dr. med., Neuroradiologie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Deutschland, Erlangen, Germany; Gusek, Gabriele, Prof. Dr. med., Augenklinik, Friedrich-Alexander-Universität Erlangen-Nürnberg , Erlangen, Germany; Michelson, Georg, Prof. Dr. med., Interdisziplinäres Zentrum für augenheilkundliche Präventivmedizin und Imaging, Augenklinik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
I72.5 + H49.1
Brain -> Intermittened Diplopia by Fusiform Aneurysm of the Basilar Artery (Neuro-Ophthalmological Exam, MRI-Angiography, OCT, Colour Image)
Trochlear paresis, basilar aneurysma, gaze direction
9299
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