PMC5465734_01
Visual field changes of a patient with severe reduction of vision in the left eye. a Findings at the initial examination. A temporal hemianopia respecting the vertical midline is present in the left eye, while the visual field of the right eye is not affected. b Three days after the endovascular surgery. The left visual field is larger than that at the initial examination with blindness (left). One month after the surgery, the left visual field recovers to the normal size (right).
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Visual field testing revealed a temporal hemianopic visual field defect in the left eye, while the visual field in the right eye was normal (Fig. 1a). OS, and the visual field was slightly enlarged from the initial examination (Fig. 1b, left). One month after the surgery, her visual acuity was further improved to 20/20 OS, and the relative afferent pupillary defect was absent on the left side. The left visual field was improved, and neither the scotoma nor the enlargement of the blind spot remained (Fig. 1b, right).
Axial T1-weighted (a) and axial T2-weighted (b) magnetic resonance images, axial T1-weighted magnetic resonance images with gadolinium enhancement (c), and coronal T1-weighted magnetic resonance images with gadolinium enhancement (d). Inside the aneurysm (indicated by an arrow in each image), a heterogeneous pattern of intensities exists with partial gadolinium enhancement.
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MRI with gadolinium enhancement revealed a round, space-occupying lesion with a diameter of 11.5 mm that was located at the suprasellar cistern which compressed the left optic nerve near the chiasma (Fig. 2).
Magnetic resonance angiography (a) and digital subtraction angiography (b). The aneurysm is indicated by an arrow in each image.
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This heterogeneous intensity pattern with partial gadolinium enhancement suggested a development of a thrombus in the aneurysm. The MR angiography and digital subtraction angiography suggested that the aneurysm protruded from the A1 segment of the anterior cerebral artery near the anterior communicating artery (Fig. 3).