Posterior ischemic optic neuropathy with acute monocular vision loss following clipping of anterior communicating artery aneurysm. A case report and review of literature

Amit Kumar Sharma; Binita Dholakia; Anita Jagetia; Ghanshyam Das Singhal; Shaam Bodeliwala; Arvind Kumar Srivastava; Daljit Singh

doi:10.25259/SNI_551_2021

Posterior ischemic optic neuropathy with acute monocular vision loss following clipping of anterior communicating artery aneurysm. A case report and review of literature

Surg Neurol Int. 2021 Sep 20:12:471. doi: 10.25259/SNI_551_2021. eCollection 2021.

Authors

Amit Kumar Sharma¹, Binita Dholakia¹, Anita Jagetia¹, Ghanshyam Das Singhal¹, Shaam Bodeliwala¹, Arvind Kumar Srivastava¹, Daljit Singh¹

Affiliation

¹ Department of Neurosurgery, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, Delhi, India.

Abstract

Background: The acute postoperative monocular vision loss following anterior communicating artery aneurysm clipping secondary to posterior ischemic optic neuropathy (PION) a rare presentation.

Case description: A 32-year old patient presented with a spontaneous holocranial thunderclap headache for 7 days, associated with vomiting. The SAH was diagnosed with a tiny saccular aneurysm arising from the anterior communicating artery. A left pterional craniotomy and clipping of aneurysm were done. On the 3^rd postoperative day, he complained of left-sided complete blindness, and on the 5^th postoperative day, his GCS dropped to E4V1M5 with right-sided hemiplegia. MRI brain showed normal optic apparatus with bilateral ACA and left MCA territory infarct.

Conclusion: The PION must be kept in the differential diagnosis of post-clipping sudden visual deterioration, especially following anterior communicating artery aneurysm rupture.

Keywords: Acomm aneurysm; Monocular blindness; Optic nerve; Posterior ischemic optic neuropathy.

Publication types

Case Reports