Document Detail

Isolated progressive visual loss after coiling of paraclinoid aneurysms.
MedLine Citation:
PMID:  17998416     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND PURPOSE: The proximity of the paraclinoid segment of the internal carotid artery to the visual pathways may result in visual deficits when patients present with aneurysms in this segment. Although surgical clip ligation of these aneurysms has been the standard of care for decades, the advent of coil embolization has permitted endovascular therapy in those aneurysms with favorable dome-to-neck ratios. Although immediate nonprogressive visual loss after coil embolization of paraclinoid aneurysms has been well described, isolated progressive visual loss immediately or shortly following coil embolization, to our knowledge, has not. We have identified 8 patients who experienced progressive loss of vision, unassociated with any other neurologic deficits, developing immediately or shortly after apparently uncomplicated coil embolization of a paraclinoid aneurysm. MATERIALS AND METHODS: This study is a retrospective case series of 8 patients seen at 4 separate academic institutions. Inpatient and outpatient records were examined to determine patient demographics, previous ocular and medical history, and ophthalmic status before endovascular embolization. In addition, details of the primary endovascular therapy and subsequent surgical and nonsurgical interventions were recorded. Follow-up data, including most recent best-corrected visual acuity, postoperative course, and duration of follow-up were documented. RESULTS: Eight patients developed progressive visual loss in 1 or both eyes immediately or shortly after apparently uncomplicated coiling of a paraclinoid aneurysm. MR imaging findings suggested that the visual loss was most likely caused by perianeurysmal inflammation related to the coils used to embolize the aneurysm, enlargement or persistence of the aneurysm despite coiling, or a combination of these mechanisms. Most patients experienced improvement in vision, 2 apparently related to treatment with systemic corticosteroids. CONCLUSION: Patients in whom endovascular treatment of a paraclinoid aneurysm is contemplated should be warned about the potential for both isolated nonprogressive and progressive visual loss in 1 or both eyes. Patients in whom progressive visual loss occurs may benefit from treatment with systemic corticosteroids.
G W Schmidt; S F Oster; K C Golnik; L M Tumialán; V Biousse; R Turbin; C J Prestigiacomo; N R Miller
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  AJNR. American journal of neuroradiology     Volume:  28     ISSN:  0195-6108     ISO Abbreviation:  AJNR Am J Neuroradiol     Publication Date:    2007 Nov-Dec
Date Detail:
Created Date:  2007-11-13     Completed Date:  2008-02-05     Revised Date:  2008-02-14    
Medline Journal Info:
Nlm Unique ID:  8003708     Medline TA:  AJNR Am J Neuroradiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1882-9     Citation Subset:  IM    
Neuro-Ophthalmology Unit, The Wilmer Ophthalmological Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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MeSH Terms
Carotid Artery Diseases / pathology,  therapy*
Carotid Artery, Internal* / pathology
Embolization, Therapeutic / adverse effects*
Intracranial Aneurysm / pathology,  therapy*
Magnetic Resonance Imaging
Middle Aged
Vision Disorders / etiology*,  pathology

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