Anterior communicating artery aneurysm presenting with vision loss
A 65 years old, gentleman presented with headache of 3 months duration, and loss of vision in right eye of 15 days duration. He was suffering from non specific headache for which he did not seek medical attention. About 15 days back his vision decreased in right eye, which progressed to complete blindness within a week. He never had sudden onset of headache with vision loss. At admission he was conscious and alert. His best corrected visual acuity was no perception of light in right eye and 6/6 in left eye. He had relative afferent pupillary defect in right eye, and brisk pupillary reaction to light in left eye. The fundoscopy revealed pale disc in right eye and normal disc in left eye. The visual fields assessment was done with computerized static visual field analysis using zeiss humphrey. The SITA FAST test was performed using goldmann parameters. Right eye could not be assessed because of poor vision. The left eye showed temporal hemianopsia. He did not have any other neurological deficits. The blood investigations revealed normal hematological and biochemical profile. The visual evoked potential revealed absence of all waves in right eye, and increased latency (N75-77.1 ms, P100-113.1 ms, and n145-157.8 ms) in left eye. Unenhanced CT scan of head showed a hyperdense suprasellar lesion. The MRI of brain showed a well defined rounded suprasellar lesion measuring 26 × 25 × 23 mm, which was composed of concentric rings of differing intensities, suggestive of partially thrombosed giant aneurysm. Post contrast MRI showed an aneurysm arising from anterior communicating artery (AComA), which was directed posteriorly []. Digital subtraction angiography (DSA) confirmed the findings on MRI []. The patient was offered surgery for securing aneurysm. As there was uncertainty about visual recovery he did not opt for any treatment and was discharged against medical advice.