Selected Case Reports

A 52-year-old female had her last ophthalmological examination in October 1985. At that time visual acuity was in both eyes 1.2. Both optic nerve heads were well defined, there was no optic atrophy. In Juli 1986 she saw a “shadow” in front of her right eye and recognized reduction of visual acuity. An ophthalmological examination on September 9, 1986 revealed a superior altitudinal visual field defect, reduction of visual acuity in the right eye to 0.2 and a central and paracentral superior altitudinal scotoma. The left eye had a visual acuity of 1.2 and a normal visual field. Reexamination on September 14, 1986 showed further reduction of visual acuity of the right eye to 0.1 and later to 0.04. At that time there was, in addition to the central scotoma, marked constriction of the visual field. CT was performed and showed the right internal carotid artery reaching deep into the right optic foramen, probably compressing the right optic nerve, which was visualized as a slit-like area of low density within the optic canal (Fig. 57). On October 27, 1986 the patient underwent decompressive surgery by a pterional approach. During surgery considerable dolichoectasia of the internal carotid artery was observed, and the right optic nerve was elevated by the ectatic vessel at the intracranial end of the optic foramen.