The ophthalmology of intracranial vascular abnormalities.
OBJECTIVE
To provide a practical review of the ophthalmologic manifestations of intracranial vascular abnormalities.


METHODS
We reviewed ocular manifestations of the most common intracranial vascular abnormalities: intracranial aneurysms, carotid-cavernous fistulas, arteriovenous malformations, and cavernous malformations.


RESULTS
Unruptured aneurysms can compress the third cranial nerve and the anterior visual pathways. Ruptured aneurysms and subarachnoid hemorrhage can result in Terson syndrome and papilledema. Direct and indirect carotid-cavernous fistulas most commonly cause the classic triad of proptosis, conjunctival chemosis, and cranial bruit but can masquerade as chronic conjunctivitis. Arteriovenous malformations, with or without hemorrhage, may compress portions of the retrochiasmal pathways, causing visual field loss. Cavernous malformations, when in the brainstem, commonly cause abnormalities of supranuclear, nuclear, and fascicular ocular motility.


CONCLUSIONS
The ophthalmologist may be the first physician to encounter clinical manifestations of intracranial vascular abnormalities that may herald devastating neurologic complications. Prompt diagnosis facilitates appropriate management and therapy.
Biousse
V
V
Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA.
Mendicino
M E
ME
Simon
D J
DJ
Newman
N J
NJ
D000328:Adult; D001164:Arteriovenous Fistula / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D002340:Carotid Artery Diseases / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D002426:Cavernous Sinus / Q000473:pathology*; D005128:Eye Diseases / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D005260:Female; D005654:Fundus Oculi; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D002538:Intracranial Arteriovenous Malformations / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012422:Rupture, Spontaneous; D013345:Subarachnoid Hemorrhage / Q000209:etiology / Q000628:therapy; D014057:Tomography, X-Ray Computed; D014794:Visual Fields