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Photo Essay
September 2004

Gaze-Evoked Amaurosis Associated With an Intracranial Aneurysm

Arch Ophthalmol. 2004;122(9):1404-1406. doi:10.1001/archopht.122.9.1404

A 53-year-old woman had right-sided, upgaze-evoked amaurosis, ptosis,facial numbness, and binocular diplopia without headache. Visual acuity was20/25 OD, decreasing to counting fingers in upgaze. The 0.3–log-unitrelative afferent pupillary defect increased to 1.5 log-units OD in upgaze.Right-central retinal artery pressure was low (right ophthalmodynamometry,0.14 g/mm Hg; left ophthalmodynamometry, 0.46 g/mm Hg). Fundus examinationshowed loss of perfusion with upgaze. Right cranial nerves III, V2, and VIand sympathetic (confirmed with 10% cocaine) palsies were present (Figure 1 and Figure 2). There was no restriction to forced ductions. There was2 mm of ptosis, 3 mm of axial and downward globe displacement (Figure 1), no resistance to retropulsion, no aberrant regeneration,no orbital congestion, and no bruit.

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