Sandwich Neurovascular Conflict of Optic Chiasm
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A 55-year-old female patient presented with a history of blurring of vision in both eyes (left > right). On visual field test, there was large central and peripheral visual field defect in the left eye [Figure 1a]. Rest of cranial nerves and neurological examination was normal. Magnetic resonance (MR) imaging with MR angiogram revealed increased signal intensity in the left half of the optic chiasm with tortuous loop of A1 segment of the right anterior cerebral artery (ACA) and supraclinoid left internal carotid artery (ICA) causing sandwich compression of the left half of optic chiasm [Figure 1b-d]. Visual loss due to dolichoectatic intracranial arteries and tumors were described in the literature. Elongated ACA rarely causes conflict with the optic pathway. Vascular compression is usually seen with the 7th and 5th cranial nerves. Our case is unique in which there is a sandwich compression of left optic chiasm by tortuous loop of contralateral ACA and ipsilateral ICA.
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