Abstract

A 49-year-old female presented with progressive painless loss of vision in her right eye (RE) over 6 months. On examination, the BCVA in her RE was hand movements only, and in her left eye was 6/6. Grade 3 RAPD was noted in the RE and fundus examination revealed a picture of primary optic atrophy in RE. There was no history of head injury or trivial trauma. She had no known systemic comorbidities. Neuroimaging revealed a large right supra-clinoid internal carotid artery aneurysm compressing the pre-chiasmatic segment of the right optic nerve, displacing the optic chiasm to the left. Immediate referral to the intervention radiologist was made. An intracranial arterial aneurysm is a ticking time bomb, which was promptly detected and managed due to a mindful systemic workup, which was lifesaving in this case.