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Case Reports
. 2022 May;28(4):296-300.
doi: 10.1177/1357633X20985392. Epub 2021 Jan 7.

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

Sally L Baxter  1   2 , David E Kuo  1 , Shira L Robbins  1
Affiliations
Case Reports

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

Sally L Baxter et al. J Telemed Telecare. 2022 May.

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.

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Conflict of interest statement

Declaration of conflicting interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
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.
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)).
See this image and copyright information in PMC

References

    1. Margolin E, Lam CTY. Approach to a patient with diplopia in the emergency department. The Journal of Emergency Medicine 2018; 54: 799–806. - PubMed
    1. Glisson CC. Approach to diplopia. Continuum (Minneap Minn) 2019; 25: 1362–1375. - PubMed
    1. Kremmyda O, Frenzel C, Hüfner K, et al. Acute binocular diplopia: peripheral or central? J Neurol. Epub ahead of print 14 August 2020. DOI: 10.1007/s00415-020-10088-y. - PMC - PubMed
    1. Nazerian P, Vanni S, Tarocchi C, et al. Causes of diplopia in the emergency department: diagnostic accuracy of clinical assessment and of head computed tomography. Eur J Emerg Med 2014; 21: 118–124. - PubMed
    1. Comer RM, Dawson E, Plant G, et al. Causes and outcomes for patients presenting with diplopia to an eye casualty department. Eye 2007; 21: 413–418. - PubMed

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