Ocular warnings of a silent killer: A case series on intracranial aneurysms

To describe the neuro-ophthalmic presentations of intracranial aneurysms (IAs) and highlight the critical role of ophthalmologists in early detection.

A retrospective, unicentric study of patients with IAs who presented to our neuro-ophthalmology clinic at a tertiary eye care center over 6 months (February-August 2024).

Nine patients with IAs were documented, of whom seven presented first to an ophthalmologist with symptoms like defective vision, diplopia, and visual field defects. Among these seven patients, the mean age was 58.9± 19.4 years (range 23-83). 71% were female. Presenting complaints included diplopia (57%) and defective vision (43%). Systemic comorbidities like diabetes and hypertension were present in 42.8%. Clinical examination revealed signs of third nerve palsy in 28.5%, sixth nerve palsy in 28.5%, and relative afferent pupillary defect and optic disc pallor in 43%. Visual field examination revealed right homonymous hemianopia in 14.2%. Magnetic resonance imaging revealed an anterior circulation aneurysm in all patients, and one also had a posterior circulation aneurysm. Multiple aneurysms were seen in 28.5%. Saccular morphology was predominant (71.4%) compared to fusiform aneurysms (28.5%).

Intracranial aneurysms may initially present with neuro-ophthalmic signs such as isolated cranial nerve palsies or compressive optic neuropathy. Timely imaging and multidisciplinary intervention are crucial to prevent permanent visual loss and life-threatening complications like rupture and subarachnoid hemorrhage. Ophthalmologists are pivotal in the early diagnosis of such potentially fatal conditions.