A Case of Traumatic Retrobulbar Arteriovenous Aneurysm

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The patient, a woman 32 years of age, entered the Clinic April 17, 1931, complaining of blindness in the right eye, protusion of the eye, and a constant swishing roar in the head synchronous with the pulse. On February 6, 1931, she had received a severe blow on the right supraorbital area in an automobile accident, the lacerations caused by this requiring suture. She immediately became unconscious and remained so for six days. On regaining consciousness she was blind in the right eye and a roaring noise was heard, which had been present constantly ever since. Hearing was diminished on the right side, and the patient was dizzy.

Examination revealed a right pulsating exophthalmos with a systolic bruit and blindness, palsy of the sixth nerve on the right side, irregular pupils, the right being larger than the left. The left pupil reacted to light and accommodation normally, the right consensually only. The palpebral fissures measured 11 mm. on the right, 8 mm. on the left. Dr. Ruedemann reported for the right eye: Convergence, marked conjunctival inflammation, pupil dilated to 5 mm., tortuosity of the ocular vessels, some edema. Disc shows definite atrophic change, the arteries and veins are approximately equal in size with some tortuosity of the vessels; definite macular hyperemia. Left eye: pupil 3 mm., disc normal.

Romberg’s sign was positive, the patient falling to the right.

Lumbar puncture showed an initial pressure of 110 mm. water, a normal response to Queckenstedt’s test, clear and colorless fluid. The spinal. . .