Bilateral Blindness After Incomplete Coiling of Small Anterior Cerebral Artery Aneurysm: Case Report and Review of Literature

BACKGROUND: Complications after coiling of large, giant, and thrombosed aneurysms because of increased mass effect on surrounding structures have been widely reported. A case of bilateral blindness after incomplete coil embolization of a small anterior cerebral artery aneurysm is rare. We review the potential mechanisms, clinical progression, and proper treatment needs. CASE DESCRIPTION: A 50-year-old man was urgently admitted with subarachnoid hemorrhage. Digital subtraction angiography (DSA) showed a ruptured aneurysm of the A1 segment, anterior cerebral artery. An endovascular coil occlusion was performed without an additional device. The visual acuity of patient slowly decreased from the 13th day after endovascular intervention. His visual acuity improved after steroid therapy but then deteriorated again. DSA showed an enlarged aneurysm, and an urgent craniotomy was performed for optic nerve decompression. The patient finally became bilaterally blind, although hyperbaric oxygen, neurotrophy drugs, and other supporting treatment was given. CONCLUSIONS: Incomplete aneurysm coiling may result in bilateral blindness, even at a small anterior cerebral artery. Early DSA, steroid therapy, and secondary craniotomy for nerve decompression should be considered promptly for improving clinical outcome before nerve atrophy, although sometimes single steroid therapy is effective.