Purtscher-like retinopathy and Horner's syndrome following coil embolization of an intracavernous carotid artery aneurysm.
BACKGROUND
Coil embolization is a non-invasive method for treating intracranial vascular malformations by inducing thrombus formation. It is particularly useful in management of cerebral aneurysms and avoids the risks associated with surgical clipping. Occasionally, embolic complications occur which result in transient or permanent loss of vision.


METHODS
Case report of a 29-year-old Caucasian woman who underwent coil embolization and balloon occlusion of an intracavernous carotid aneurysm. Shortly thereafter she described visual changes and a droopy eyelid.


RESULTS
Examination revealed pupillary miosis and mild ptosis of the right upper lid. Perimetry showed an arcuate scotoma superiorly and an inferonasal step in the right eye. Fundus examination revealed multiple cotton-wool spots along the peripapillary area and along the temporal vascular arcades reminiscent of Purtscher retinopathy. After 4 weeks, she had marked improvement in her visual symptoms. Most of the cotton-wool spots had resolved and the visual field had normalized. However, the ptosis and anisocoria remained unchanged.


CONCLUSIONS
Coil embolization is a non-invasive method for treating carotid aneurysms. However, it carries the risk of ophthalmic events, warranting baseline ophthalmic examinations prior to such intervention.
Castillo
Bienvenido V
BV
Department of Ophthalmology, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA. bcastil@lumc.edu
Khan
Ahsan M
AM
Gieser
Richard
R
Shownkeen
Harish
H
D000328:Adult; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D002343:Carotid Artery, Internal; D002404:Catheterization; D002426:Cavernous Sinus; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D005260:Female; D006732:Horner Syndrome / Q000209:etiology*; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D011859:Radiography; D012164:Retinal Diseases / Q000209:etiology*