Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society
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A 72-year-old woman with a painful left third cranial nerve palsy due to a basilar artery aneurysm situated between the superior cerebellar and posterior cerebral arteries was treated with Guglielmi detachable coils (GDCs). Despite a good initial angiographic result with a small residual neck and improvement in the ocular motility and pain, the patient experienced worsening of the third cranial nerve palsy 15 months later. Cerebral angiography confirmed coil compaction with aneurysmal regrowth. ⋯ The patient experienced complete resolution of the pain and partial resolution of the third cranial nerve palsy. In some patients, a small residual aneurysm neck after endovascular embolization therapy with GDCs can result in delayed aneurysmal regrowth due to coil compaction. Clinical manifestations may herald this dangerous regrowth.
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An 81-year-old woman with chronic dementia developed lethargy, confusion, binocular blindness, and episodic left-beating nystagmus. Diffusion magnetic resonance imaging (MRI) revealed high signal in the right occipital region suggesting recent ischemia. ⋯ A single photon emission computed tomography (SPECT) performed during the seizure epoch showed bilateral occipital lobe hyperperfusion. This is the second report to document SPECT bi-occipital hyperperfusion in seizure-related cortical blindness.
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A 43-year-old woman developed right frontal headache and decreased vision in her OD 14 months after treatment of an intracranial aneurysm by wrapping with cotton gauze. A junctional visual field defect was present, and an MRI revealed a contrast-enhancing mass involving the right optic nerve, lateral chiasm, optic tract, and cavernous sinus. Biopsy demonstrated a marked inflammatory reaction mixed with strands of birefringent cotton gauze. ⋯ Most cases have occurred in women and involved the optic nerves or chiasm. Visual improvement has sometimes occurred after treatment with abscess drainage, debulking, and/or corticosteroids. A rare complication of aneurysm wrapping, gauzomas causing visual loss have been reported up to 54 months after surgery.