Article
Intraorbital hemorrhage from an intraorbital malformation? – No, from a ruptured ophthalmic aneurysm! A case report
Intraorbitale Blutung aus einer intraorbitalen Malformation? – Nein, aus einem rupturierten A. ophthalmica-Aneurysma! Ein Fallbericht
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Authors
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F. Lohmann
- Neurochirurgische Klinik, Klinikum Dortmund
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R. Schultheiß
- Neurochirurgische Klinik, Klinikum Dortmund
| Published: | May 8, 2006 |
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Outline
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Objective: Spontaneous intraorbital hemorrhage is rare and generally results from trauma or from vascular or tumorous malformations in the orbit. We present the unusual case of an intraorbital hemorrhage due to a ruptured ophthalmic aneurysm without subarachnoid hemorrhage.
Methods: A 54-year-old female was admitted with acute exophthalmus, an impaired visual acuity of her left eye, diplopia and 2 days history of headache, nausea and vertigo. Ophthalmologic and neurologic examination revealed a visual acuity of 0.8 deteriorating to 0.6 within the same day and an incomplete inhibition of globe motility of the left eye. CT/MR imaging showed an intraorbital non contrast enhancing mass indicating hemorrhage into a vascular or tumorous lesion but no intracranial hemorrhage, and CT-angiography demonstrated no intraorbital vascular malformation but an unexpected left paraclinoid aneurysm. Transcranial surgical resection of the intraorbital space-occupying lesion was required to relieve the mass effect, the aneurysm was clipped in the same session.
Results: After aneurysm clipping a hemorrhage clot was removed from the orbit extending to the apex. Histologic evaluation showed no vascular malformation, e.g. a cavernous hemangioma, but a one week old hemorrhage. The patient's postoperative course was complicated by vasospasm of the left ophthalmic artery treated with nimodepin and hemodilution and a secondary subgaleal hemorrhage extending into the orbit requiring operative evacuation. Gradually the globe immobility resolved, no proptosis was observed, the visual acuity of the left eye was 0.5 on discharge. Control angiography demonstrated a complete occlusion of the ophthalmic aneurysm.
Conclusions: Nontraumatic intraorbital hemorrhage is generally caused by intraorbital malformations. Since a ruptured ophthalmic aneurysm usually presenting with intracranial subarachnoid hemorrhage is rarely suspected angiography is necessary to establish the diagnosis. Immediate surgery is required to minimalize functional deficits and to prevent rehemorrhage.
