Visual Loss Associated with Fusiform Enlargement of the Intracranial Portion of the Internal Carotid Artery

UR purpose is to discuss a syndrome which is characterized by progressively diminishing visual acuity and peripheral vision in one or both eyes after the age of 80 years. At exploratory craniotomy or necropsy, the terminal segment of the internal carotid artery is found to be enlarged and to displace the ipsilateral optic nerve upward against the superior rim of the optic foramen. Caramazza described the clinical findings of ~ unconfirmed cases in 193~. 2 Linear sellar calcifications were noted on the skull films, and a correlation with an arteriosclerotic process was suggested. In 1934, Schloffer 7 reported his experience with a 65-year-old woman who complained of a loss of vision in the right eye of 5 years' duration, a recent visual defect on the left of 6 weeks, plus headache, dizziness, and diplopia. Examination revealed decreased vision and field defects in both eyes. The right disc was atrophic and the left was raised with ~ diopters of papilledema. Because of the apparent Foster Kennedy syndrome a frontal tumor was diagnosed. A right frontal eraniotomy was performed and no tumor was found, but the right internal carotid artery was enlarged and compressed a thinned optic nerve upward. The left nerve was not visualized. At post-mortem, it was found that both internal carotid arteries and both optic nerves were equally involved. It was felt that decompression of one or both optic foranlina might have been beneficial. In 1938, Glees described 3 eases that had come to his attention with the diagnosis of