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Washington University Experience | VASCULAR | Aneurysm - Giant | 2A0 Case 2 History
Case 2 History ---- This 69 year old woman was admitted to Barnes Hospital in November, 1977. She had a previously known diagnosis of a large left cavernous sinus carotid artery aneurysm and a small left anterior cerebral artery aneurysm. The patient had been in good neurologic health until 1974 when she developed diplopia. The aneurysms were felt to be non-operable. Since that time, there was gradual development of neurologic signs and symptoms. By 1975, she had developed complete ptosis of the left eye and by July 1977 apparent complete loss of function of cranial nerves II, III, lV, and VI of the left eye. During the last month prior to her final admission, the patient noted decreased sensation in the distribution of the left trigeminal nerve in an ophthalmic distribution. Approximately 3 days prior to admission, she developed acute left temporal throbbing headache associated with vomiting. There was no vertigo, no eye swelling or tearing and no visual loss on the right. On neurologic examination she was oriented, her mental status was unremarkable and there was a left ptosis with a large left pupil which was non-reactive to light. No papilledema or hemorrhages were present in the fundi. The extraocular movements were full on the right, but there was left complete III, IV, and VI paresis. There was an absent corneal response on the left and decreased pin sensation in V1 distribution of the Vth cranial nerve. The remainder of V was unremarkable. The neck was supple. The remainder of the neurologic examination including motor/sensory coordination and reflexes was unremarkable. While in the hospital, the patient had progression of her left Vth cranial nerve symptoms, demonstrating expansion of the aneurysm. She was considered for surgical intervention, but died suddenly in the early morning of November 11, 1977, and could not be resuscitated.
