Seminars in Ophthalmology , Early Online, 1–4, 2014 ! Informa Healthcare USA, Inc. ISSN: 0882-0538 print / 1744-5205 online DOI: 10.3109/08820538.2014.912548 CASE REPORT Unruptured Giant Intracranial Aneurysm of the Internal Carotid Artery: Late Ocular Symptoms Mia Zoric Geber 1 , Iva Krolo 1 , Ognjen Zrinscak 1 , Eugenia Tedeschi Reiner 1 , and Dario Josip Zivkovic 2 1 University Department of Ophthalmology and 2 University Department of Neurosurgery, University Clinical Center ‘‘Sestre Milosrdnice’’, Zagreb, Croatia ABSTRACT An unruptured giant intracranial aneurysm of the internal carotid artery may tend to present with late ocular symptoms. This is the case of a 58-year-old female patient with a giant unruptured aneurysm of the right internal carotid artery. The patient presented with exclusively progressive reduction of visual acuity and visual field defects due to the mass effect of the growing aneurysm. The rupture of the aneurysm occurred before planned treatment. Clinical suspicion and timely recognition as well as prompt treatment play an important role in the final outcome of the management of giant unruptured intracerebral aneurysms. Keywords: Aneurysm size, anterior intracranial circulation, mass effect, subarachnoid hemorrhage, vascular abnormalities, visual field defect INTRODUCTION Intracranial aneurysms are defined by size as small ( 5 10 mm), large ( 5 25 mm), and giant ( 4 25 mm). 1 The average incidence of giant aneurysms is 5% in various studies. 1–3 Giant brain aneurysm is a severe disease with respect to both the diagnosis and treatment. The onset of the disease is usually sudden and without warning. The most common symptoms are subarachnoid hemorrhage or local mass effect mimicking a slowly growing tumor. 1,4 The symptoms depend on the location and size of the aneurysm. The risk of the rupture rises as the aneurysm size increases. 1,5,6 The giant aneurysm may cause neurological symptoms but rarely symptoms of intracranial hypertension. 7 Internal carotid artery (ICA) is the predominant localization of giant intracranial aneurysms (GIA) associated with a high risk of rupture and poor clinical outcome. 5 MATERIALS AND METHODS A 58-year-old female patient presented with decreased visual acuity in her left eye. She had no previous medical history other than an amblyopic right eye. She was myopic with a prescribed correc- tion of À5.50 SPH with À1.25 CYL in the right eye and À4.75 SPH and À1.00 CYL in the left eye. A standard ophthalmic exam revealed bestÀcorrected Snellen visual acuities of 20/100 in the right eye and 20/30 in the left eye. A complete eye exam was normal in both eyes. One month later, the patient returned for further deterioration of visual acuity, counting fingers in the right eye and 20/100 in the left eye with a relative afferent pupillary defect. Visual field exam- ination revealed incongruent hemianopia in the right eye and dense central scotoma in the left eye (Figure 1A, B). Five days later, the patient presented to our clinic and underwent another visual field exam- ination. The exam revealed even further deterioration Correspondence: Mia Zoric ´ Geber, University Department of Ophthalmology, University Clinical Centre ‘‘Sestre Milosrdnice,’’ Vinogradska 29, 10000 Zagreb, Croatia. E-mail: miazoricgeber@gmail.com Received 3 April 2014; accepted 24 April 2014; published online 14 May 2014 1 Semin Ophthalmol Downloaded from informahealthcare.com by University of Victoria on 04/08/15 For personal use only.