Dreadful twins: Twin unruptured aneurysms of bilateral intracranial arteries

Abstract

history of horizontal, binocular diplopia, and ptosis of 2 months' duration. No history of fever or weight loss was present. Her past history revealed occasional headaches for the last 3 years, which were of the throbbing type with no association of nausea, vomiting, tinnitus or transient visual obscurations. She ignored these symptoms due to their responsiveness to analgesics and absence of any hindrance to her daily activities. The patient did not have any history of hypertension, prior central nervous system(CNS) anomalies or vascular malformations. Her examination revealed bilateral optic disk pallor and her visual acuity was 20/40 bilaterally: Visual fields were normal by confrontation method and extra-ocular muscle examination revealed bilateral external ophthalmoplegia: Bilateral involvement of medial rectus, superior rectus, inferior rectus, inferior oblique,and superior oblique. Lateral rectus was unilaterally involved on the right side [Figure 1]. Intracranial aneurysms are the most common cause of subarachnoid hemorrhage which carries a significant risk of mortality. Mirror aneurysm constitute between 5-12% of all the intracranial aneurysms. These are uncommon entities with poorly understood pathogenesis and clinical significance. Key words: Mirror aneurysms, ophthalmoplegia, subarachnoid hemorrhage : ‫البحث‬ ‫ملخص‬ ‫يسمى‬ ‫ما‬ ‫يشكل‬ .‫الوفاة‬ ‫الحتمال‬ ‫المريض‬ ‫على‬ ‫كبيرة‬ ‫خطورة‬ ‫ذلك‬ ‫ويشكل‬ ‫شيوعا‬ ‫األكثر‬ ‫السبب‬ ‫الجمجمة‬ ‫داخل‬ ‫الشرايين‬ ‫تمدد‬ ‫يعتبر‬ ‫بالكامل‬ ‫معروفة‬ ‫غير‬ ‫والمرضية‬ ‫السريرية‬ ‫أهميتها‬ ‫أن‬ ‫غير‬ ،‫الجمجمة‬ ‫داخل‬ ‫الشرايين‬ ‫توسعات‬ ‫كل‬ ‫من‬ 5-12% ‫بين‬ Mirror Aneurysun