Abstract 101: Ophthalmic Artery Aneurysm Embolization Resulting in Resolution of Headaches and Visual Symptoms

Abstract

Introduction Cerebral aneurysms are a rare cause of headaches and visual symptoms. Most common locations include anterior communicating artery, internal carotid arteries (ICAs), middle cerebral arteries, and tip of the basilar artery. While most unruptured aneurysms are asymptomatic, when symptoms do occur, they are most often headaches, cranial nerve palsies, or bilateral temporal hemianopsia due to compression of surrounding nerves or the optic chiasm. Rarely, thrombus formation within an aneurysm can lead to symptoms via distal embolization and infarction. The literature is limited regarding repeated aneurysmal microembolism formation or transient alterations in blood flow dynamics leading to episodic symptoms. Methods We report the case of a 55 year‐old woman with Ehlers‐Danlos syndrome and syringomyelia who presented to the hospital with one week of intermittent left eye visual disturbances, characterized by either complete transient monocular vision loss or blurriness lasting for 30 seconds at a time and occurring multiple times per day. These symptoms were also associated with pressure‐like headaches that originated around the left eye and radiated to the left side of her head. Results Neurological and ophthalmological examinations were notable for normal cranial nerve function, including intact visual acuity, visual fields, color vision and extraocular movements in each eye. On a dilated fundoscopic exam, there were no retinal or optic disc abnormalities. The rest of the neurological exam was normal. Head and neck CTA and subsequent digital subtraction angiography (DSA) showed multiple bilateral ICA aneurysms, as well as a 4 millimeter left ophthalmic artery aneurysm. Brain and orbits MRI with contrast showed no acute abnormalities, including no evidence of infarction or intracranial hemorrhage. She was started on clopidogrel due to concern for recurrent retinal transient ischemic attacks as well as escalating doses of nortriptyline for empiric treatment of possible ocular migraines. In follow‐up three months later, she continued to have the same visual and headaches symptoms. She underwent a successful elective flow diversion embolization of the ophthalmic artery aneurysm with subsequent resolution of her symptoms Conclusion Here we describe a case of a patient who presented with episodic monocular vision changes and headaches ipsilateral to an ophthalmic artery aneurysm, who experienced complete resolution of these symptoms following flow diversion embolization of the aneurysm. Although the precise pathophysiological relationship between the aneurysm and her visual symptoms is unclear, potential mechanisms include aneurysmal microthrombus formation with retinal embolization and dissolution, hemodynamic retinal blood flow changes related to the aneurysm, or recurrent ocular migraines triggered by the ophthalmic artery aneurysm.