Last year I had three unruptured aneurysms successfully embolised (I have never had an SAH my aneuryms were found completely by accident during an MRI scan which was carried out as I had had an episode of Bells Palsy from which I made a full recovery and also some ear pain and my ENT specialist could find no problem with my ears - this ear pain is no longer with me now, so the aneurysms were found by accident. )These aneurysms were in the Left superior cerebellar artery, the right internal carotid artery and the left internal carotid artery. I also have two very small aneurysms which are being monitored (a left internal carotid anuerysm and a middle cerebral artery aneurym). The three aneurysms that were coiled were coiled during two seperate procedures four months apart the last procedure being one year ago. Apart from hypertension which is well controlled on medication I have no other health problems.
I have recently had an MRA check up on last years surgeries and to monitor the untreated aneuryms, the MRA showed that all three coiled aneurysms remain 100% occluded and that there has been no growth or change to the untreated aneurysms.
However, I still have pain/pressure feeling behind my left eye which started following my diagnostic angiogram, 18 months ago, it is an intermittent pain and usually is cleared with standard pain killers, but sometimes just moving my eye is very painful.. I can also get blurred vision,all my eye problems are confined to my left eye. Occassionally I seem to get numbers mixed up, I still can also feel fatigued. This is causing me problems at work. My neurosurgeon has told me that my brain scan is normal (the brain tissue etc) and the surgery has been a complete sucess. I will continue to have yearly MRA’s to monitor the two remaining aneurysms. There is no furring up in my cerbral arteries in fact they all look fine.He doesnt think it has anything to do with the surgery etc. I am aware from support groups that people that have had aneurysms can get these symptoms but these people all seem to be people who have had a SAH, I havent, so I am at a loss as to what is causing the problem and why I have these symptoms, I could understand it immediately post operatively but it has been a year since my last surgery. I dont know whether I should be seeing a neurologist or seeing someone else. I had my vision tested a few months ago by an optician who did lots of eye tests and said the blood vessels behind my eye etc were fine and everything else optical wise was ok.
Dr. Joshua’s Answer
I’m happy that your embolization treatment has gone well and you are in a good situation, having had multiple aneurysms succesfully treated and the small aneurysms followed up properly. Treating aneurysms, whether by coiling or clipping, is a serious business and there are always risks.
Just like your neurosurgeon, I cannot immediately connect in my mind your eye symptoms and the diagnostic angiography. Theoretically, angiography and coiling of the carotid tip aneurysm, or misplacement of the coils, could result in traumatic damage to vessels near the eye, possibly even caroticocavernous fistula, which is a type of traumatic shunt between the carotid artery and a venous structure called the cavernous sinus. Another hypothetical possibility is minor ischemic (lack of blood an oxygen) damage to the eye or the cranial nerves.
Any procedure performed on brain vessels may result in minor complications and symptoms that are hard to diagnose exactly. Memory disturbances, visual disturbances, and headaches are amongst them. While true that they are usually associated with ruptured aneurysms, it is not inconceivable that treatment of multiple unruptured aneurysms may result in unexplained symptoms.
On the other hand, your symptoms may be more or less unrelated. Migraine is a possibility. A thorough history and physical examination is needed. Is there any swelling, tears, redness, rash? There are many possible causes for eye pain, ranging from trigeminal neuralgia to herpes infection.
I would like to see you examined by a neuro-ophthalmologist. Examination by an optician, or even by a regular eye doctor, may not be sufficient in your case. Following that, a consultation with a neurologist might be in order. Ask your endovascular surgeon about the procedure and explain your symptoms, to get his/her take on the matter. Also, keep talking to your neurosurgeon. Rely on these professionals and keep in mind that it is not always possible to pinpoint the cause of such symptoms.
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