Neurophthalmicaspects ofcerebral aneurysm clinical manifestations

Abstract

Objective – is to investigate the characteristics of neurophthalmic symptoms of patients with cerebral arterial aneurysm (AA).

Materials and methods. The results of examination of 70 patients (38 (54.3 %) women and 32 (45.7 %) men) with AA were analyzed, which were on treatment in the period from 2013 to 2016. The complex examination of patients according to the «Algorithm of rendering medical care to a patient with acute impairment of cerebral circulation according to the SAK type» (Appendix to the order of the Ministry of Health No. 317 of 13-06-2008) in groups was conducted. Group 1 (Gr. 1) – 13 (18.6 %) patients had pseudotumorous type of clinical manifestations of the disease, group 2 (Gr. 2) – 57 (81.4 %) patients were in acute period (up to 30 day) of hemorrhagic stroke as a result of rupture of the AA. Neurophthalmic examination included clinical and neurological examination, visometry, perimetry, biomicroscopy, ophthalmoscopy.

Results. Persistent impairment of visual function after the treatment was revealed in 16 (23 %)

from 70 (100 %) patients (Gr. 1 – in 8 (61.5 %) from 13 patients--------- 12 eyes; Gr. 2 – in 8 (14 %)

from 57 patients – 16 eyes). For Gr. 1 a gradual decrease in visual acuity from 3 months to 2 years was characteristic. In 43 (75.4 %) patients from Gr. 2 were observed «transient» impairments of visual functions at least during 1 year before the hemorrhagic manifestation of disease. In moment of AA rupture, visual impairments in all patients occurred suddenly: ahemophthalmia – in 2 patients (2 eyes), bilateral hemorrhagic (central) retinitis – in 1 patient (2 eyes), bilateral stagnant discs optic nerves in the initial stage – in 2 patients (4 eyes), unilateral posterior optical ischemic neuropathy – in 3 patients (3 eyes) – totally 8 (14 %) patients. Oculomotor disorders of a transitory nature in Gr. 2 were caused by the lesion of the oculomotor, block and deflecting cranial nerves in 35 (61.4 %) patients.

Conclusions. Neurophthalmic manifestations of AA depend on the localization of AA and the variant of the disease clinical manifestations. Transitory violation of visual functions in patients with AA can be harbingers of AA rupture. The development of a posterior optical neuropathy in patients with AA rupture – is an adverse factor in the prospect of visual functions restoring. Microsurgical interventions in patients with AA with external decompression of the optic and oculomotor nerves have a positive effect on restoring the vision function.