Bilateral intra-orbital ophthalmic artery aneurysms

Clinical details: A 52-year-old man presented with neck pain, nausea and vomiting (Hunt-Hess grade 1). CT scan showed subarachnoid hemorrhage. Cerebral angiography showed multiple arterial aneurysms (right communicating posterior, right anterior choroid, left pericallosal, intraorbital ophthalmic bilaterally). All aneurysms but intraorbital ophthalmic ones were treated with endovascular embolisations. As the intraorbital aneurysms were asymptomatic no treatment was performed. The patient was dismissed without any neurological deficits. Discussion: Intraorbital ophthalmic aneurysms are very uncommon, with extremely rare rupture. No treatment is indicated when the aneurysm is unruptured and asymptomatic. Surgical treatment is advised only after rupture or symptomatic mass effect. © 2009 Springer-Verlag.