Aneurysm of the Internal Carotid Artery with Atrophy and Compression of the Optic Nerve

Abstract

A patient who complained of failing of vision in the left eye and pains in the left side of the head was observed at intervals over the course of one year. Fundus examination showed, on the left side, secondary optic atrophy, increase of connective tissue on the nerve head, and progressive atrophic excavation of the nerve head. Visual-field studies revealed progressive contraction for form in the left eye. Death occurred in coma shortly after a sudden attack of severe headache. Autopsy showed leptomeningeal and cortical hemorrhage and an aneurysm of the left internal carotid artery, over the surface of which was stretched the flattened and partially degenerated left optic nerve. There were evidences of renal and vascular disease, and no evidence of syphilis. Recent opinion gives arteriosclerosis and bacterial infection, especially progressive malignant endocarditis, acting on a congenitally weak vessel wall, as the most frequent causes of aneurysm. A review of the finer anatomy of the region suggests the mode of action by which aneurysm of the internal carotid artery may compress the optic nerve and bring about its atrophy. Clinical diagnosis before rupture of the aneurysm is rare. The clinical picture varies widely with the rate of development of the aneurysm. A patient who complained of failing of vision in the left eye and pains in the left side of the head was observed at intervals over the course of one year. Fundus examination showed, on the left side, secondary optic atrophy, increase of connective tissue on the nerve head, and progressive atrophic excavation of the nerve head. Visual-field studies revealed progressive contraction for form in the left eye. Death occurred in coma shortly after a sudden attack of severe headache. Autopsy showed leptomeningeal and cortical hemorrhage and an aneurysm of the left internal carotid artery, over the surface of which was stretched the flattened and partially degenerated left optic nerve. There were evidences of renal and vascular disease, and no evidence of syphilis. Recent opinion gives arteriosclerosis and bacterial infection, especially progressive malignant endocarditis, acting on a congenitally weak vessel wall, as the most frequent causes of aneurysm. A review of the finer anatomy of the region suggests the mode of action by which aneurysm of the internal carotid artery may compress the optic nerve and bring about its atrophy. Clinical diagnosis before rupture of the aneurysm is rare. The clinical picture varies widely with the rate of development of the aneurysm.