A brain lesion located at the lateral side of the sella turcica can produce a junctional scotoma by compressing the ipsilateral optic nerve and the contralateral inferonasal nerve fiber. This study reports a female patient with a junctional scotoma caused by a cerebral aneurysm. At the initial visit, she complained of visual disturbance in both eyes and the right optic disc was atrophied. The visual field showed right blindness and left superotemporal quadrantopsia. A brain CT indicated an approximately 3 cm sized brain mass located superolateral to the sella turcica. The brain MRI showed the lesion to be more like an aneurysm than a pituitary adenoma. Therefore, 4 vessels angiography was done, and this lesion was confirmed to be a sellar variant of an aneurysm located at the right carotid siphon. Like a tumor of the optic chiasm, a cerebral aneurysm can cause visual disturbance and visual field defects. Therefore, an early differential diagnosis is important because the prognosis and treatment of an aneurysm differ.
Aged ; Cerebral Angiography ; Female ; Human ; Intracranial Aneurysm/*complications/radiography ; Magnetic Resonance Imaging ; Optic Nerve Diseases/diagnosis/*etiology ; Scotoma/diagnosis/*etiology ; Tomography, X-Ray Computed ; Visual Fields

Three-dimensional computed tomographic (3D-CT) angiography is a widespread imaging modality for intracranial vascular lesions. However, 3D-CT angiograms of an anterior communicating artery aneurysm associated with acute retrobulbar optic neuropathy have not been previously described. We present 3D-CT angiograms of an aneurysm of the anterior communicating artery that caused subarachnoid hemorrhage and vision loss in a 39-year old man. The 3D-CT angiograms were consistent with findings identified directly during surgery.
Acute Disease ; Adult ; Cerebral Angiography/*methods ; Diagnosis, Differential ; Follow-Up Studies ; Humans ; *Imaging, Three-Dimensional ; Intracranial Aneurysm/complications/*radiography ; Male ; Optic Nerve Diseases/etiology/*radiography ; Tomography, X-Ray Computed/*methods