Exophtalmie unilatérale révélant un géant anévrysme intra caverneux rompu de la carotide interne

Giant aneurysm of the intracranial carotid artery is a relatively rare disorder which can lead to life-threatening consequences. Ophthalmologic symptoms, mainly oculomotor nerve palsies, usually reveal lesions of the cavernous sinuses. We report the case of a 39-year old female patient presenting with rapidly progressive unilateral exophthalmos (A,B) and binocular diplopia associated with tension headaches causing a single episode of vomiting evolving in a context of apyrexia and general state preservation. Ophthalmologic examination found isolated palsies of the right lateral rectus muscle (abduction deficit). Static and dynamic assessment of the eyelids was normal. Corrected visual acuity was 5/10. Slit lamp exam showed dilation of the conjunctival vessels(C), clear cornea that didn’t take up fluorescein, preserved direct and consensual pupillary light reflex, intra-ocular pressure 15 mmhg and venous tortuosities at the back of the eye without papillary abnormalities (D). Neuroradiological assessment, such as magnetic resonance angiography, showed compressive aneurysms of the intracavernous portion of the right internal carotid artery with grade III exophthalmos. Cerebral angiography objectified right giant ruptured saccular carotid-cavernous aneurysm in the cavernous sinuses (E).with anterior and posterior venous drainage associated with aneurysm of the left carotid syphon (F).