Internal carotid artery aneurysm presenting as diplopia via telemedicine during COVID-19

Abstract

A patient presented with acute onset of double vision during the start of the COVID-19 pandemic when elective medical care was restricted. Initially declining an in-person evaluation, she was examined using a telehealth video visit, incorporating multiple technological modalities to ascertain ophthalmic examination elements. Her findings prompted emergent neuroimaging, revealing a giant internal carotid artery aneurysm, which was successfully embolized to prevent debilitating and possibly fatal intracranial haemorrhage. This case report illustrates the successful use of telemedicine and remote patient data acquisition to make a life-saving diagnosis.

Keywords: COVID-19; Remote consultation; pandemic; tele-ophthalmology; telehealth; telemedicine; teleneurology.

Figure 1.

Photographic montage of eye positions for a patient presenting with acute binocular diplopia. The patient had acquired these images at home using a smartphone application (9 Gaze app, See Vision LLC, Richmond, VA, USA). She had a subtle abduction deficit in the right eye (middle image in the left-most column, highlighted in red), which was more noticeable during dynamic examination at the time of the telemedicine video visit.

Figure 2.

Giant internal carotid artery (ICA) aneurysm visualized on neuroimaging. The white arrows highlight various views of the partially thrombosed giant aneurysm arising from the right cavernous ICA, which measured 3.4 × 3.1 × 2.6 cm, on both magnetic resonance images (a) and computed tomography angiography (b). There was also a 2 mm aneurysm projecting posteriorly from the left ICA terminus (blue arrow in (b)).