Neuro-ophthalmic Assessment in Unruptured Intracranial Aneurysms

Abstract

ith increased use of noninvasive imaging of the brain, there has been an increased detection of W incidental, unruptured intracranial aneurysms (UIAs) (1). Unlike in the setting of aneurysmal subarachnoid hemorrhage (SAH), when a patient can present with significant neurologic impairment, a patient seen in the outpatient clinic with a UIA may have no symptoms at all. Management strategies for UIAs must balance the prevention of lifethreatening SAH with the potential morbidity and mortality of the aneurysm treatment itself, whether by surgical or endovascular means. In contrast, a patient presenting with cranial nerve palsy from a UIA, such as an oculomotor nerve palsy resulting from local compressive effect of an ipsilateral posterior communicating artery aneurysm, is a classic neurosurgical emergency where we recommend expedited repair of the aneurysm, even in the face of seemingly contradictory evidence from prospective studies suggesting that symptoms are not necessarily associated with UIA rupture (10). Several studies have sought to develop scoring systems for rupture risk or rupture plus treatment risk (2, 3).