CLINICAL PRESENTATION (contd) 2. Compression from aneurysm sac (7%)
A large internal carotid artery aneurysm (or anterior communicating artery aneurysm) may compress -
the pituitary stalk or hypothalamus causing hypopituitarism the optic nerve or chiasma producing a visual field defect the pituitary stalk or hypothalamus causing hypopituitarism
A basilar artery aneurysm may compress the midbrain pons, or III nerve producing limb weakness or impaired eye movements
A posterior communicating artery aneurysm may produce a III nerve palsy. This indicates aneurysm expansion and the need for urgent treatment. Alternatively, it occurs concurrent with S AH.
Intracavernous aneurysms may compress -
IV nerve VI nerve first trigeminal division and ganglion producing ophthalmoplegia and facial pain
3. Incidental finding (3%)
Angiography performed for reasons other than SAH, e.g. investigation of ischaemic or neoplastic disease, occasionally reveals previously undetected aneurysms.
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