Anterior Communicating Artery Aneurysm Visual Symptoms [Neurosurgery Wiki]

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====== Anterior Communicating Artery Aneurysm Visual Symptoms ======

The AComA aneurysms rupture before becoming large enough to compress [[visual pathway]]s, hence they present with [[aneurysmal subarachnoid hemorrhage]] rather than [[visual symptoms]]
((Kasner SE, Liu GT, Galetta S. Neuroophthalmologic aspects of aneurysms. Neuroimaging Clin N Am. 1997;7:679–92.)).

[[Giant anterior communicating artery aneurysm]]s are extremely rare and may present with vision loss
((Lownie SP, Drake CG, Peerless SJ, Ferguson GG, Pelz DM. Clinical presentation and management of giant anterior communicating artery region aneurysms. J Neurosurg. 2000;92:267–77.)).

Visual apparatus compression can occur from giant AComA aneurysm directed posteriorly and inferiorly
((Shukla DP, Bhat DI, Devi BI. Anterior communicating artery aneurysm presenting
with vision loss. J Neurosci Rural Pract. 2013 Jul;4(3):305-7. doi:
10.4103/0976-3147.118765. PubMed PMID: 24250165; PubMed Central PMCID:
PMC3821418.)).

The pattern of visual loss in these cases is variable. The common pattern of visual loss is bilateral field deficits.

The other patterns of visual loss due to AComA aneurysms are central scotoma, bilateral heteronymous deficits, monocular or binocular inferior field loss, asymmetrical bitemporal hemianopsia, and incongruous homonymous hemianopsia
((Kasner SE, Liu GT, Galetta S. Neuroophthalmologic aspects of aneurysms. Neuroimaging Clin N Am. 1997;7:679–92.)).
----
Since [[internal carotid artery aneurysm]]s and [[anterior communicating artery aneurysm]]s are located closely to the [[optic nerve]], it is frequently observed during surgery that aneurysm compresses the [[optic nerve]]
((Cullen JF, Haining WM, Crombie AL. Cerebral aneurysms presenting with visual
field defects. Br J Ophthalmol. 1966 May;50(5):251-6. PubMed PMID: 5933563;
PubMed Central PMCID: PMC506226.
))
((Date I, Asari S, Ohmoto T. Cerebral aneurysms causing visual symptoms: their
features and surgical outcome. Clin Neurol Neurosurg. 1998 Dec;100(4):259-67.
PubMed PMID: 9879851.
))
((Norwood EG, Kline LB, Chandra-Sekar B, Harsh GR 3rd. Aneurysmal compression of
the anterior visual pathways. Neurology. 1986 Aug;36(8):1035-41. PubMed PMID:
3736868.
)).

In most cases, visual symptoms are uncommon in patients, even though intracranial aneurysm may compress the optic pathway. However, in case of large intracranial aneurysm, such visual impairment may be observed due to the pressure from the aneurysm
((Peiris JB, Ross Russell RW. Giant aneurysms of the carotid system presenting
as visual field defect. J Neurol Neurosurg Psychiatry. 1980 Dec;43(12):1053-64.
PubMed PMID: 7217950; PubMed Central PMCID: PMC490777.
))
((Højer-Pedersen E, Haase J. Giant anterior communicating artery aneurysm with
bitemporal hemianopsia: case report. Neurosurgery. 1981 Jun;8(6):703-6. PubMed
PMID: 7279157.
))
, which are anatomically close to the anterior optic pathway and the arteries from the Circle of Willis (prevalent site of the intracranial aneurysm). Accompanied symptoms include unilateral scotoma or blindness owing to the pressure on the nerve, bitemporal hemianopsia caused by the pressure on the optic chiasm or homonymous hemianopsia due to compression on the optic tract. Such symptoms progress slowly, as with the increasing size of intracranial aneurysm, repeating multiple cycles of improvement and deterioration that are explained by development of a thrombus in the intracranial aneurysm as well as its expansion
((Park JH, Park SK, Kim TH, Shin JJ, Shin HS, Hwang YS. Anterior communicating
artery aneurysm related to visual symptoms. J Korean Neurosurg Soc. 2009
Sep;46(3):232-8. doi: 10.3340/jkns.2009.46.3.232. Epub 2009 Sep 30. PubMed PMID: 
19844624; PubMed Central PMCID: PMC2764022.
)). 

===== Terson's Syndrome =====

see [[Terson's Syndrome]]


===== References =====