Vision problems after cavernous arterial aneurysm

[CdHa]

In July 2007, I experienced extreme double vision and sixth nerve eye palsy- caused by a cavernous arterial aneurysm.  I was in initially scheduled for a stint repair; however as the aneurysm was so large (about the size of the eye) the neurologist could not utilize this procedure- rather used the Coilization procedure. The surgery was performed on 29 October 2007, and relieved the eye nerve palsy- as well as double vision in both eyes.  However, for the last 4 months, I have begun experiencing vision problems in my right eye.

The blurriness only affects the inside view of vision in my right eye, meaning the peripheral vision in this eye is clearer. This symptom appears to be worsening, and my headaches are also growing in intensity. Is this symptom typical for this type of aneurysm? Will I eventually loose my sight in one or both of my eyes? Is there any treatment to prevent worsening of this condition? I have had the follow up Arterial grams - the coil is still in place, I have also been to the ophthalmologist and there is no evidence of damage to the eye or the optic nerve.

Additionally, at the time of the aneurysm, I went to three different hospitals before getting a correct diagnosis-then only after I demanded more than just pain medication. My headache was so bad that my hair hurt. At one hospital I was told, by one of the ER nurses, that there was nothing wrong with me- and that he even doubted my vision complaint. Now doing research, I see these symptoms are typical of this type of aneurysm. I do not understand why if so many people are having the same symptoms and these symptoms relate to this form of aneurysms- that the doctors and staff are not automatically checking for this life threatening condition.

[Ray T Oyakawa, MD]

There has to be damage somewhere if you have a visual field loss.  The pupil issue may be due to damage to the pupillary fibers of the third nerve.  Not too much of a concern.

Is the neuro-ophthalmologist a neurologist by training?  If so see an ophthalmologist about blurred vision.

[CdHa]

I thank you sir for your quick response. The diagnosis was made through the Dallas Veterans Hospital, Dallas Texas; surgery was performed at the UT Southwestern University Hospital - Zale Lipshy, Dallas, Texas. Optometry, Ophthalmology and Neurologic Ophthalmology are through the Veterans Hospital, Dallas.

After surgery I was referred to the Ophthalmologist who indicated there was no damage to the eye or the optic nerve but some vision loss for which I now require corrective lenses. This week, I sneezed and caused temporary blurriness in both eyes which lasted approximately one to one and a half hours. I was re-hospitalized through the Veterans Hospital, Dallas, Texas and under went a gamut of in-patient testing to include Arterial Doppler, CT, MRI and other tests to rule out a stroke or TIA with the discharge diagnosis Visual Loss- TIA.

During hospitalization the Neurologic Ophthalmologist confirmed the lack of damage to the eye but has not provided a prognosis nor has he given an exact diagnosis for the cause of blurred of vision in this eye. During the examination and testing he indicated a loss in my field of vision and noted an occasional pupil dilation issue. I have a scheduled appointment with the VA Ophthalmologist for 20 January 2009 and would be appreciative of any information and knowledge I could obtain before this appointment. Are there any websites or other locations where one could learn information on this issue? Again I would like to thank you for your valued time on this issue.

[Ray T Oyakawa, MD]

What hospital was the surgery done at?  One of the best centers for this type of problem is the University of California at San Francisco.  They have a great team of neurosurgeons, neurologists, neuroradiologists, and neuroophthathalmologists .

I would recommend you see a neuro-ophthalmologist regarding your right eye.

ERs are not a good place to go to for rare conditions.