Anterior communicating artery aneurysm presenting with vision loss (2023)

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  • J Neurosci Rural Pract
  • v.4(3); Jul-Sep 2013
  • PMC3821418

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Anterior communicating artery aneurysm presenting with vision loss (1)

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J Neurosci Rural Pract. 2013 Jul-Sep; 4(3): 305–307.

Dhaval P. Shukla, Dhananjaya I. Bhat, and Bhagavatula I. Devi

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See commentary "Commentary" onpage307.

(Video) Transradial Stent-Assist Coil Embolization of an Anterior Communicating Artery (ACOM) Brain Aneurysm


Anterior communicating artery aneurysm rarely presents with symptoms of compression of anterior visual pathways. We report a case of 65 years old man, who had complete loss of vision in right eye and temporal hemianopsia in left eye due to giant anterior communicating artery aneurysm.

Keywords: Aneurysm, anterior communicating artery, optic nerve, vision loss


The aneurysms originating from carotid-opthalmic artery, supraclinoid internal carotid artery, and internal carotid artery bifurcation are more likely to present with symptoms of anterior visual pathway compression.[1] We describe a rare case of anterior communicating aneurysm presenting with vision loss.

Case Report

A 65 years old, gentleman presented with headache of 3 months duration, and loss of vision in right eye of 15 days duration. He was suffering from non specific headache for which he did not seek medical attention. About 15 days back his vision decreased in right eye, which progressed to complete blindness within a week. He never had sudden onset of headache with vision loss. At admission he was conscious and alert. His best corrected visual acuity was no perception of light in right eye and 6/6 in left eye. He had relative afferent pupillary defect in right eye, and brisk pupillary reaction to light in left eye. The fundoscopy revealed pale disc in right eye and normal disc in left eye. The visual fields assessment was done with computerized static visual field analysis using zeiss humphrey. The SITA FAST test was performed using goldmann parameters. Right eye could not be assessed because of poor vision. The left eye showed temporal hemianopsia. He did not have any other neurological deficits. The blood investigations revealed normal hematological and biochemical profile. The visual evoked potential revealed absence of all waves in right eye, and increased latency (N75-77.1 ms, P100-113.1 ms, and n145-157.8 ms) in left eye. Unenhanced CT scan of head showed a hyperdense suprasellar lesion. The MRI of brain showed a well defined rounded suprasellar lesion measuring 26 × 25 × 23 mm, which was composed of concentric rings of differing intensities, suggestive of partially thrombosed giant aneurysm. Post contrast MRI showed an aneurysm arising from anterior communicating artery (AComA), which was directed posteriorly [Figure 1]. Digital subtraction angiography (DSA) confirmed the findings on MRI [Figure 2]. The patient was offered surgery for securing aneurysm. As there was uncertainty about visual recovery he did not opt for any treatment and was discharged against medical advice.

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Figure 1

MRI of brain (a) T1W, axial section showing a rounded suprasellar lesion which is composed of alternate concentric rings of iso and hyperintensities (b) T2W, coronal section showing suprasellar lesion with hypointense rim and center of heterogeneous intensities (c) T2W, saggital section showing suprasellar lesion of mixed intensities (d) T1W, after contrast administration saggital section showing suprasellar lesion with brillian enhancement in center in continuity with anterior cerebral artery

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Figure 2

(a) DSA, right carotid injection, antero-posterior view, showing an aneurysm arising from anterior communicating artery directed inferiorly (b) DSA, lateral view, showing an aneurysm arising from anterior communicating artery directed posteriorly


Large or giant aneurysm arising from anterior part of circle of Willis can result in visual symptoms as it is in close proximity to anterior visual pathways. The visual loss due to aneurysms is characterized by fluctuation, unlike that from tumors where visual loss is gradually progressive. These fluctuations are due to thrombosis or intermittent dilatation of aneurysm.[1] The common origins of aneurysms that present with symptoms of anterior visual pathway compression are carotid-opthalmic artery, supraclinoid internal carotid artery, and internal carotid artery bifurcation. Aneurysms arising from these arteries are often large or giant and can compress the visual apparatus. The AComA aneurysms rupture before becoming large enough to compress visual pathways, hence they present with subarachnoid hemorrhage rather than visual symptoms.[1] Giant AComA aneurysms are extremely rare and may present with vision loss.[2] Visual apparatus compression can occur from giant AComA aneurysm directed posteriorly and inferiorly as in our case.[1,2] The pattern of visual loss in these cases is variable. The common pattern of visual loss is bilateral field deficits.[1] Presentation with only monocular acute visual loss is very rare, and when it occurs, contralateral eye is more often affected.[3] The other patterns of visual loss due to AComA aneurysms are central scotoma, bilateral heteronymous deficits, monocular or binocular inferior field loss, asymmetrical bitemporal hemianopsia, and incongruous homonymous hemianopsia.[1] In our case, patient presented with subacute monocular visual loss. The opposite side temporal field defect was detected only on detailed visual field assessment, for which patient was asymptomatic. The visual field deficit might have started with bitemporal hemianopsia due to chiasm compression, which would have not been noticed by the patient. The right optic nerve would have got compressed later, presenting with monocular visual loss. The common mechanism of visual loss is compression and ischemia due to giant aneurysm, as in our case, and direct hemorrhage in the optic nerve or chiasm due to rupture of smaller aneurysm.[1] The penetration, splitting, or fenestration of optic nerves by aneurysms is extremely rare.[4]

The predictability of recovery of vision is poor in case of aneurysmal visual loss. In a review of 165 cases of aneurysmal visual loss, visual function improved in 70% cases, remained unchanged in 21%, and worsened in 9% after surgical clipping. There was no significant relationship between visual recovery and aneurysm location, aneurysm size, or presence of subarachnoid hemorrhage. Surgical clipping was significantly associated with better visual outcome as compare to endovascular coiling.[5] As the numbers of cases of visual loss due to AComA are rare the exact figure of visual outcome is not available.[6] The results of treatment are variable ranging from no improvement to complete recovery.[7] A patient with only a direct compression of the nerve by the aneurysm with no bleed can be expected to improve after surgery.[3]


Source of Support: Nil.

Conflict of Interest: None declared.

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1. Kasner SE, Liu GT, Galetta S. Neuroophthalmologic aspects of aneurysms. Neuroimaging Clin N Am. 1997;7:679–92. [PubMed] [Google Scholar]

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3. Bhat DI, Sampath S. Anterior communicating artery aneurysm presenting as monocular blindness. Br J Neurosurg. 2011;25:644–6. [PubMed] [Google Scholar]

4. Horiuchi T, Uchiyama T, Kusano Y, Okada M, Hongo K, Kobayashi S. Penetration of the optic nerve or chiasm by anterior communicating artery aneurysms: Three case reports. Neuro-ophthalmology. 2011;35:128–32. [Google Scholar]

5. Schuss P, Güreseir E, Berkefeld J, Seifert V, Vatter H. Influence of surgical or endovascular treatment on visual symptoms caused by intracranial aneurysms: Single-center series and systematic review. J Neurosurg. 2011;115:694–9. [PubMed] [Google Scholar]

6. de Oliveira JG, Borba LA, Rassi-Neto A, de Moura SM, Sanchez SL, Júnior, Rassi MS, et al. Intracranial aneurysms presenting with mass effect over the anterior optic pathways: Neurosurgical management and outcomes. Neurosurg Focus. 2009;26:E3. [PubMed] [Google Scholar]

7. Chan JW, Hoyt WF, Ellis WG, Gress D. Pathogenesis of acute monocular blindness from leaking anterior communicating artery aneurysms: Report of six cases. Neurology. 1997;48:680–3. [PubMed] [Google Scholar]

Articles from Journal of Neurosciences in Rural Practice are provided here courtesy of Scientific Scholar


How does anterior communicating artery aneurysm related to visual symptoms? ›

Anterior communicating artery aneurysm can cause visual symptoms by compressing the optic nerve or direct rupture to the optic nerve with focal hematoma formation.

What are the symptoms of an unruptured anterior communicating artery aneurysm? ›

The most common presenting signs and symptoms of unruptured intracranial aneurysms include headache, reduced visual acuity, double vision, and other cranial nerve neuropathies that are usually attributed to mass effect imposed by the aneurysm to nearby neural structures.

Can aneurysm cause loss of vision? ›

Also, brain aneurysm symptoms can occur if the aneurysm presses on adjacent structures, such as the optic nerves. In this case, the patient can experience symptoms such as a loss of vision or double vision even if the aneurysm has not ruptured.

What are the deficits of anterior communicating artery aneurysm? ›

Approximately 18% of ACoA aneurysm survivors will have some form of cognitive deficit, of which severe amnesia is the most common. Anterograde amnesia is characterized by delayed recall deficits for verbal and nonverbal material and memory recall is worse than recognition.

What is the prognosis for anterior communicating artery aneurysm? ›

Out of the patients with a surgically treated aneurysm and SAH (114 patients), 77 (68%) experienced a good recovery, 9 (8%) moderate disability, 12 (10%) severe disability, 9 (8%) vegetative state, and 7 death (6%).

Can an aortic aneurysm cause eye problems? ›

Aortic dissection can present with neurologic symptoms pertaining to vision when the dissection compromises the ophthalmic artery. The most common visual symptom associated with this phenomenon is amaurosis fugax.

How common is an anterior communicating artery aneurysm? ›

Anterior communicating artery aneurysms account for 23–40% of ruptured intracranial aneurysms and 12–15% of unruptured aneurysms and are the most common intracranial ruptured or unruptured aneurysms.

What are the visual symptoms of aneurysm? ›

Symptoms of an unruptured brain aneurysm can include: visual disturbances, such as loss of vision or double vision. pain above or around your eye. numbness or weakness on 1 side of your face.

Should an unruptured aneurysm be treated? ›

For an unruptured brain aneurysm, your doctor will decide whether it's better to treat the aneurysm now or monitor you carefully (called watchful waiting). Certain aneurysms are more likely to bleed, or rupture. A rupture is a critical and potentially life-threatening situation.

Can vision be restored after aneurysm? ›

It is not common for an isolated visual symptom to be the first indication of an aneurysm compressing the optic nerve. The compression can lead to blindness, and a recovery from the blindness is rare. We report a female with a left painless optic neuropathy caused by an unruptured anterior cerebral artery aneurysm.

Which artery causes sudden vision loss? ›

Central retinal artery occlusion is the blockage of blood to the retina of one eye. It usually causes sudden loss of eyesight in one eye. You are higher risk if you are older or have high blood pressure, glaucoma, or diabetes. You are also at higher risk if your blood is thicker and stickier than normal.

Can an eye exam detect a brain aneurysm? ›

During a comprehensive eye exam, an eye care provider can detect increased pressure in the brain, including swelling of the optic nerve or bleeding into the retina of the eye, which may indicate an aneurysm is present.

What part of the brain does the anterior communicating artery supply? ›

To summarize, the ACA supplies the medial and superior parts of the frontal lobe, and the anterior parietal lobe. The short anterior communicating artery joins the two anterior cerebral arteries.

What is the most common aneurysm in the anterior communicating artery? ›

The ACoA is a common site for brain aneurysms, which occur when the walls of a blood vessel are weakened by some insult, such as infection or degenerative illness. Often the vessel will rupture, causing a hemorrhage and destruction of the surrounding brain tissue.

What does the anterior communicating artery control? ›

Anterior communicating artery, an important component of circle of Willis, acts as collateral channel to stabilize blood flow.

How do you treat anterior communicating artery aneurysms? ›

Endovascular treatment is an effective method for the treatment of anterior communicating artery aneurysms allowing late rebleeding prevention. Peri-treatment rebleeding warrants caution in anticoagulation management. This is a single center experience and the follow-up period is limited.

What is the most difficult aneurysm to treat? ›

Although responsible for only 3%-5% of all cerebrovascular aneurysms, basilar artery aneurysms (BAAs) are among the most difficult to treat.

Can you live a long life with an unruptured aneurysm? ›

An unruptured brain aneurysm may cause zero symptoms. People can live with them for years before detection.

Can an aortic aneurysm cause blindness? ›

It is not common for an isolated visual symptom to be the first indication of an aneurysm compressing the optic nerve. The compression can lead to blindness, and a recovery from the blindness is rare.

What does aneurysm pain behind eye feel like? ›

Dilated pupils, blurred or double vision, and eye-region pain (a headache behind eyes, a headache between eyes, or a headache above eyes) all could be signs to seek medical attention: They may be brain aneurysm symptoms signaling that a blood vessel in the brain is leaking or is about to rupture.

How long can you have an aortic aneurysm before it ruptures? ›

The larger an aneurysm is, the greater the chances are that it will rupture. It is estimated that an abdominal aortic aneurysm that is over 5.5 cm in diameter will rupture within one year in about 3 to 6 out of 100 men.

Which type of aortic aneurysm is most likely to rupture? ›

Abdominal aortic aneurysm

Women with AAA generally suffer ruptures more often and with smaller sizes of aneurysms. The rupture of an abdominal aortic aneurysm is a medical emergency, and only about 20% of patients survive.

What is the normal size of the anterior communicating artery? ›

We found that the anterior communicating artery had a mean length of 2.80 mm (range 1.5–5.9 mm) and a mean diameter of 1.11 mm (range . 59–2.1 mm). Further research on anterior communicating artery can be done by including radiological and surgical findings too.

What are the symptoms of anterior communicating artery stroke? ›

This can include poor coordination and decreased control of the limbs, face, and tongue. Urinary Incontinence: Incontinence, or a lack of urinary control, has been reported as a symptom in many cases of ACA stroke.

Are there warning signs days before an aneurysm? ›

A severe headache that comes out of nowhere (often described as the worst headache one has ever felt) Blurred vision. Feeling nauseated. Throwing up.

What is life expectancy after aneurysm? ›

On average, patients who underwent repair for a ruptured aneurysm lived 5.4 years after surgery. Researchers found no significant differences in relative five-year survival rates between men and women or between age groups. However, researchers found differences in the repair of intact aneurysms.

What triggers an aneurysm? ›

Causes of aneurysms

high blood pressure (hypertension) over many years resulting in damage and weakening of blood vessels. fatty plaques (atherosclerosis) resulting in a weakness of the blood vessel wall. inherited diseases that may result in weaker than normal blood vessel walls.

How serious is a 4 mm aneurysm? ›

Aneurysms that are: Less than 3 mm in size have a low risk of rupture. Larger than 3 mm have a higher risk of bursting.

What should you avoid with an unruptured aneurysm? ›

If you have an unruptured brain aneurysm, you may lower the risk of rupture by making these lifestyle changes:
  • Don't smoke cigarettes. ...
  • Control your blood pressure if you have high blood pressure.
  • Eat a healthy diet and exercise. ...
  • Don't use drugs such as cocaine, methamphetamine or others.
Mar 7, 2023

How serious is a 5 mm aneurysm? ›

aneurysms larger than 5 mm in patients younger than 60 years of age should be seriously considered for treatment; large, incidental aneurysms larger than 10 mm should be treated in nearly all patients younger than 70 years of age.

What is the treatment for an eye aneurysm? ›

Treatment is controversial as the usual treatment—laser occlusion—can lead to bleeding at that time. They can be surrounded by laser burns which lessens the risk of bleeding. This should be discussed with a retinal specialist.

Is there a neurological deficit after a brain aneurysm? ›

Chronic headache or head pain (mainly ruptured aneurysms) Concentration headaches. Vision deficits: partial or complete blindness, or peripheral vision deficits. Cognitive problems (such as short-term memory difficulties, decreased concentration, perception problems)

Do you lose your memory after a brain aneurysm? ›

Memory involves many parts of the brain, and if a brain aneurysm rupture or treatment damages any of those areas, your memory will be affected. Survivors of ruptured aneurysms usually do not remember the event or much of what happened in the hospital, and never will. This can be disconcerting but is normal.

What is the most common vascular cause of vision loss? ›

Retinal Vein Occlusion: RVO causes the veins in the eye to become narrowed or obstructed. RVO is a leading cause of vascular-related blindness. If the condition affects the optic nerve, the patient is said to have Central Retinal Vein Occlusion (CRVO).

Is loss of vision a mini stroke? ›

Temporary vision loss can be a sign of an impending stroke—it requires immediate medical attention. Or, it can be a symptom of a stroke that's already occurred. Vision complications due to a stroke depend on where the stroke occurs.

Why do I suddenly lose vision in one eye? ›

Common causes of sudden vision loss include eye trauma, blockage of blood flow to or from the retina (retinal artery occlusion or retinal vein occlusion), and pulling of the retina away from its usual position at the back of the eye (retinal detachment).

Can you get a disability check for brain aneurysm? ›

If you are suffering from the effects of a brain aneurysm you may qualify for disability benefits. The Social Security Administration recognizes brain aneurysms as an impairment in their Blue Book and you may qualify for disability benefits if certain conditions are met.

What is the best imaging to rule out brain aneurysm? ›

Magnetic resonance angiography (an MRI scan) is usually used to look for aneurysms in the brain that haven't ruptured. This type of scan uses strong magnetic fields and radio waves to produce detailed images of your brain.

What can be mistaken for a brain aneurysm? ›

People can mistake an aneurysm for a migraine headache, delaying care and possibly leading to significant harm. It is important to learn the differences and what to do when warning signs of an aneurysm are present.

Which symptom is associated with an anterior artery occlusion? ›

Distinctive symptoms in ACA territory infarction include altered mental status, abulia, mutism, decreased verbal fluency, aphasia, and urinary incontinence [3, 4]. Abulia and mutism are associated with cingulate gyrus and supplementary motor area involvement; these areas are important for human behaviour [17,18,19].

What characterize the common clinical manifestation of an arterial aneurysm? ›

Persons with AAAs that have ruptured may present in many ways. The most typical manifestation of rupture is abdominal or back pain with a pulsatile abdominal mass. However, the symptoms may be vague, and the abdominal mass may be missed. Symptoms may include groin pain, syncope, paralysis, and flank mass.

What neurological signs would you expect from a posterior communicating artery aneurysm? ›

While most unruptured PCOM aneurysms are asymptomatic, when symptoms do occur, clinical manifestations typically include severe headache (HA), visual acuity loss, and cranial nerve deficit.

What happens if you have an aneurysm behind your eye? ›

Unruptured aneurysm

Symptoms of an unruptured brain aneurysm may include: Pain above and behind one eye. A dilated pupil. A change in vision or double vision.

What is the most common presenting symptom of acute arterial occlusion? ›

The classic presentation of acute arterial occlusion involves the "six Ps" pallor, pain, paresthesia, paralysis, pulselessness, and poikilothermia. [9] These clinical manifestations can occur anywhere distal to the occlusion. Most patients initially present with pain, pallor, pulselessness, and poikilothermia.

What is the function of the anterior communicating artery? ›

Anterior communicating artery, an important component of circle of Willis, acts as collateral channel to stabilize blood flow.

What is the gold standard for the diagnosis of aneurysms? ›

Cerebral angiography can be used to help diagnose an aneurysm, arteriosclerosis, arteriovenous malformation, vasculitis, brain tumors, blood clots, or tears in the lining of an artery.

What are the 3 most common sites of aneurysms? ›

More than 90% are located at one of the following five sites: (a) the internal carotid artery at the level of the posterior communicating artery; (b) the junction of the anterior cerebral and anterior communicating arteries; (c) the proximal bifurcation of the middle cerebral artery; (d) the junction of the posterior ...

What is the hallmark of aneurysm rupture? ›

The hallmark symptom of a ruptured aneurysm is a sudden and severe headache. Other symptoms differ, depending on the location of the aneurysm and how much blood has seeped into the brain. Symptoms may include: Coma or loss of consciousness.


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