More to it than meets the eye: a case report of incomitant esotropia in a child caused by a giant basilar aneurysm  

作　　者：Tianwei Ellen Zhou Carmen Parra Farinas Abhaya VKulkarni Peter Dirks Leonardo RBrandão Prakash Muthusami Nasrin Najm-Tehrani 

机构地区：[1]Department of Ophthalmology and Vision Sciences,University of Toronto,Toronto,Ontario,Canada [2]Department of Diagnostic Imaging,the Hospital for Sick Children,University of Toronto,Toronto,Ontario,Canada [3]Department of Neurosurgery,the Hospital for Sick Children,University of Toronto,Toronto,Ontario,Canada [4]Division of Haematology/Oncology,Department of Pediatrics,the Hospital for Sick Children,University of Toronto,Toronto,Ontario,Canada [5]Dalla Lana School of Public Health,University of Toronto,Toronto,Ontario,Canada [6]Department of Ophthalmology,the Hospital for Sick Children,University of Toronto,Toronto,Ontario,Canada

出　　处：《Annals of Eye Science》2023年第4期1-5,共5页眼科学年鉴（英文）

摘　　要：Background:Esotropia is a common concern in pediatric ophthalmology consultations.While most cases stem from strabismus,it is crucial for physicians to differentiate atypical features that might indicate underlying organic causes,such as VI nerve palsy,hinting at the presence of intracranial spaceoccupying lesions.Although the occurrence of cerebral aneurysms in children is rare,they can have severe consequences.Case Description:Here,we described an extremely rare case of giant basilar fusiform aneurysm measuring 4.0 cm×3.9 cm×3.9 cm in an otherwise healthy 8-year-old child,and analyzed its atypical features that suggested an intracranial etiology.We further described an endovascular approach,performed by interventional radiologists,and discussed its advantages over the conventional neurosurgery.The patient continued to be followed by our multidisciplinary team.He had a stable post-operative course and made an excellent recovery neurologically.At the 1-year follow-up,he was orthophoria with excellent vision and stereopsis.Conclusions:To our knowledge,this is the first pediatric case in Canada where a giant intracranial aneurysm was treated endovascularly.The salient red flags—progressive incomitant esotropia and diplopia,the presence of myopia(rather than hyperopia),nystagmus and abnormal saccadic movements—should be astutely recognized by clinicians as intracranial giant aneurysms carry a poor prognosis.A multidisciplinary approach is essential for the management of such cases.

关 键 词：Sixth nerve palsy incomitant esotropia giant basilar aneurysm interventional radiology case report 

分 类 号：R777.41[医药卫生—眼科]