Case Report April 01, 2026 April 01, 2026

Detecting a large saccular aneurysm before symptom onset: the value of neuro-ophthalmological evaluation

DOI: 10.37039/1982.8551.20260026

ABSTRACT

The aim of this case report was to demonstrate the importance of the neuro-ophthalmological examination, particularly the assessment of the pupillary reflex, in identifying neurological abnormalities in asymptomatic patients, highlighting its crucial role in the early detection of intracranial aneurysms, even in the absence of evident clinical signs. This is an observational, retrospective, and descriptive case report of a 70-year-old male patient with chronic glaucoma. During a routine ophthalmological evaluation, a relative afferent pupillary defect was identified in the right eye, leading to the request for cranial and orbital magnetic resonance imaging for further investigation. Magnetic resonance imaging revealed a large saccular aneurysm (1.5 × 1.2 × 1.5 cm) in the communicating segment of the right internal carotid artery, in contact with adjacent brain structures, without prior symptoms. The patient was referred for specialized neurological follow-up and intraocular pressure control. The neuro-ophthalmological assessment allowed the early detection of a potentially fatal lesion in an asymptomatic patient, emphasizing the importance of regular ophthalmological examinations and an interdisciplinary approach in the diagnosis of severe neurological conditions.