Optic pathway infarct after Onyx HD 500 aneurysm embolization: visual pathway ischemia from superior hypophyseal artery occlusion

BMJ Case Rep. 2013 Dec 17:2013:bcr2013010968. doi: 10.1136/bcr-2013-010968.

Abstract

We report a case of visual deterioration after Onyx HD 500 embolization of a left 7 mm superior hypophyseal artery (SHA) aneurysm. After the procedure, the patient experienced a right incongruous homonymous hemianopia, and MRI showed an infarct of the ipsilateral optic chiasm/tract but no evidence of aneurysm mass effect or embolic cortical infarcts. The optic pathway ischemia is believed to be secondary to Onyx penetration and occlusion of an SHA branch near the aneurysm neck. Caution is advised when using liquid embolic agents to treat SHA aneurysms as SHA occlusion may lead to visual deficits.

Keywords: Aneurysm; Angiography; Liquid Embolic Material; MRI; Stroke.

Publication types

  • Case Reports

MeSH terms

  • Carotid Artery Diseases / therapy
  • Carotid Artery, Internal / pathology
  • Dimethyl Sulfoxide / adverse effects
  • Dimethyl Sulfoxide / therapeutic use*
  • Embolization, Therapeutic / adverse effects*
  • Embolization, Therapeutic / methods
  • Hemianopsia / etiology
  • Humans
  • Infarction / etiology
  • Intracranial Aneurysm / therapy*
  • Ischemia / etiology*
  • Ischemia / pathology
  • Middle Aged
  • Optic Chiasm / diagnostic imaging
  • Optic Chiasm / pathology*
  • Polyvinyls / adverse effects
  • Polyvinyls / therapeutic use*
  • Radiography
  • Visual Pathways / diagnostic imaging
  • Visual Pathways / pathology*

Substances

  • Onyx HD 500
  • Polyvinyls
  • Dimethyl Sulfoxide