title: Ophthalmic segment of internal carotid artery aneurysm mimicking normal tension glaucoma.
abstract: A 41-year-old caucasian male was referred to the Glaucoma clinic at our tertiary referral centre with a diagnosis of normal tension glaucoma after the finding of increased bilateral asymmetrical cup/disc ratios, with normal intraocular pressures. On examination, the authors confirmed the presence of bilateral reduced optic disc rims alongside a left pale residual rim, and a further discovered a positive dyschromatopsia with a bilateral visual field alteration. The left visual field showed a relative scotoma confined to the vertical midline. After initiating investigation for suspected glaucoma, the authors ordered a magnetic resonance imaging that evidenced an internal carotid aneurysm along the ophthalmic segment, stretching across the optic chiasm with a major involvement of the left optic nerve and partial involvement of the right optic nerve. Aneurysm embolisation was performed with complete resolution of signs and symptoms achieved 5 months post-operatively. Despite glaucoma being the most frequent condition causing optic disc atrophy and visual field loss, it is not the only cause. Any atypical visual field defect not in keeping with a glaucomatous field loss should be further investigated. The ophthalmologist should thoroughly assess all signs that could lead to different diagnosis.
authors.affiliation: Ophthalmology Unit, Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Via Montpelier 1, 00133, Rome, Italy. nucci@med.uniroma2.it.
authors.forename: Carlo
authors.initials: C
authors.lastname: Nucci
authors.affiliation: Ophthalmology Unit, Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Via Montpelier 1, 00133, Rome, Italy.|Moorfields Eye Hospital, NHS Foundation Trust, London, UK.
authors.forename: Francesco
authors.initials: F
authors.lastname: Aiello
authors.affiliation: Ophthalmology Unit, Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Via Montpelier 1, 00133, Rome, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Giuliano
authors.affiliation: Department of Bioimaging and Radiological Sciences, Catholic University, Rome, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Colosimo
authors.affiliation: Ophthalmology Unit, Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Via Montpelier 1, 00133, Rome, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Mancino
mesh_terms: D000328:Adult; D000783:Aneurysm / Q000175:diagnosis* / Q000000981:diagnostic imaging; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D006801:Humans; D057066:Low Tension Glaucoma / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D008297:Male; D009880:Ophthalmic Artery / Q000473:pathology*; D014786:Vision Disorders / Q000175:diagnosis
keywords: Intracranial carotid artery aneurysm; Magnetic resonance imaging; Normal tension glaucoma; Visual field defect