Ruptured Vertebral Artery Dissecting Aneurysm as a Risk Factor for Ocular Symptoms Accompanied with Subarachnoid Hemorrhage

OBJECTIVE: Although ruptured vertebral artery dissecting aneurysms (VADAs) are often associated with ocular symptoms, such as abducent nerve palsy and Terson syndrome (TS), their frequency and risk factors in comparison with those associated with ruptured aneurysms in other locations have not been reported. METHODS: Three hundred forty-three patients with nontraumatic subarachnoid hemorrhage were treated in our hospital from April 2002 to May 2016, among which 35 (10.2%) had VADA as the origin of hemorrhage. They were analyzed retrospectively for risk factors of ocular symptoms. RESULTS: Of the 343 patients, 26 had eye movement disturbance (7.6%) and 22 had TS (6.4%). Both eye movement disturbance (14 patients; 40.0%; P < 0.0001) and TS (10 patients; 28.6%; P < 0.0001) occurred more frequently in the VADA than the non-VADA group. Abducent nerve palsy accounted for all eye movement disturbances associated with ruptured VADA, although it occurred in 6 of 12 affected patients with ruptured aneurysms in other locations. Of these patients, 4 improved within 3 months (28.6%) and 8 did so within 1 year (66.7%). Multivariate logistic regression analysis indicated that ruptured VADA is a risk factor for both eye movement disturbance and TS (P < 0.0001 and P = 0.0033; 95% confidence interval of odds ratio: 3.41-29.5 and 1.72-14.33, respectively). CONCLUSIONS: Eye movement disturbance and TS occurs more frequently in patients with ruptured VADA than with aneurysms in other locations. Early evaluation by an ophthalmologist is recommended in these patients.