Giant cavernous carotid aneurysm with spontaneous ipsilateral ICA occlusion: Report of 2 cases and review of literature
A 65-year-old lady presented with 3-month history of facial numbness and occasional pain involving the left half of the forehead and left cheek and left sided ptosis. The symptoms were insidious in onset and not associated with any history suggestive of a subarachnoid hemorrhage. Clinical examination revealed complete ophthalmoplegia and hypoesthesia in the ophthalmic and maxillary divisions of the left trigeminal nerve.\nShe was evaluated with an MRI [Figure and ] which showed a giant partially thrombosed aneurysm in the left ICA cavernous segment. She was planned for a DSA with possible balloon test occlusion. DSA revealed complete occlusion of left ICA, without any filling of the aneurysm [Figure and ]. There was excellent cross-flow through anterior communicating artery, which was supplying the entire left hemisphere. There was no filling of the aneurysm through the right ICA or vertebral artery injection. MRA [] revealed lack of flow through the left ICA and the cavernous aneurysm.\nThe patient was managed conservatively and was put on aspirin to prevent further progression of the thrombus. At 6 month follow-up, the patient was doing well, her ophthalmoplegia had completely improved however, the pain and numbness over the left half of the face persisted.