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

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.

• Authors: Jeremiah Nicholas Johnson, Mohamed Elhammady, Judith Post, Joshua Pasol, Koji Ebersole, Mohammad Ali Aziz-Sultan
• Journal: Journal of neurointerventional surgery (J Neurointerv Surg) Vol. 6 Issue 9 Pg. e47 (Nov 2014) ISSN: 1759-8486 [Electronic] England
• PMID: 24362967 (Publication Type: Case Reports, Journal Article)
• Copyright: Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Chemical References

• Onyx HD 500
• Polyvinyls
• Dimethyl Sulfoxide

Topics

• Brain Ischemia (surgery)
• Cerebral Arterial Diseases (etiology)
• Cerebral Infarction (etiology)
• Dimethyl Sulfoxide (adverse effects)
• Embolization, Therapeutic (adverse effects)
• Hemianopsia (etiology)
• Humans
• Intracranial Aneurysm (complications, therapy)
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Polyvinyls (adverse effects)
• Treatment Outcome
• Visual Pathways (pathology)