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Dr. Stan
Dr. Stan, Ophthalmologist
Category: Eye
Satisfied Customers: 2690
Experience:  Johns Hopkins Fellowship Trained, Certified and Licensed Medical Physician and Surgeon
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I have a history of cerebral aneurysms with coiling procedures

Resolved Question:

I have a history of cerebral aneurysms with coiling procedures X 2, 5 years ago. My left eye is at 4-5 mm & barely reactive since the event. Past 3 days I have had periorbital swelling to L eye. No pain, No itching. I have had a off/on stiff neck for 2-3 weeks. No fever. No nasal discharge. No increase in HA. No sore throat. Eye swelling goes down temporarily with ice. No eye discharge seen. Left sinus burned about one week ago, just for a few minutes & stopped. Hasn't happened again.
Submitted: 3 years ago.
Category: Eye
Expert:  Dr. Stan replied 3 years ago.
Hello,

Welcome to Just Answer:

It is likely that you are experiencing the symptom of dilated non-reactive pupil due to the cerebral aneurysm and/or repair that affected sympathetic nerves of the pupil, causing the pupil to remain more dilated. The recent periorbital swelling of the left eye is likely related to underlying inflammation and/or infection, and I suggest that extension of any sinus infection to the eye and/or the brain be exclude with tests including CT Scan of the orbit and brain. It is also important to closely evaluate the area of the brain with the aneurysm to exclude any bleed and/or infection contributing to the intermittent stiff neck. Complete blood count, blood culture, gram stain, urinalysis, and/or CSF lumbar tap may be considered. In the meantime, I suggest that you follow-up with your eye doctor for closer evaluation and possible prescription for medication such as dicloxacillin 500 mg 4 times daily for 10 days. In addition, I suggest that you switch to using warm/hot compresses twice daily for 2 weeks.

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Customer: replied 3 years ago.
Thank you Dr. Stan- Yes the pupil issue is due to scar tissue/coiling to the artery along the optic nerve that contols my left eye. It is chronic. I mentioned it so that you'd have a more complete idea of why I am nervous. Is it possible to have intermittent neck stiffness with
meningitis/ cerebral bleed ? I did mention the stiff neck to my PCP, however he suggested that it was a muscle issue. The eye swelling that started 3 days ago was an addition to this vague picture that finally concerned me. Do I need to head to the ER? I do NOT want to have an all-day event there for something benign- but just cannot decide if this is an emergent issue. Also, my local hospital is rural so on the weekend I would only be able to have a CT (no MRI services on weekends) I have had so many CT's I am concerned about the raditation effects. Thanks much for your help.
Expert:  Dr. Stan replied 3 years ago.
Thank you so much:

I'm concerned about the possibility of meningitis or cerebral bleed - at least these need to be excluded, even if it is possible that muscle issue could be causing this symptom. The reason for the increase vigilance with your case is due to your history of cerebral aneurysm with coils. Getting the complete evaluation to exclude such possibility should be very reassuring and comforting even if one have to spend time at the emergency room. My suggestion is that if the symptoms persist or worsen at any time, that you follow-up in the emergency room or urgent care center for closer evaluation.

It was a pleasure to assist you. Please, allow me get credit for my time and effort in assisting you and press the ACCEPT button for this assist. I will be glad to answer additional questions until you are satisfied. Thank you so much.

A Positive Feedback and/or Bonus is welcomed and appreciated.

Please note that this answer is for information only. It cannot be substituted for the visit to or the recommendation of your doctor.
Dr. Stan, Ophthalmologist
Category: Eye
Satisfied Customers: 2690
Experience: Johns Hopkins Fellowship Trained, Certified and Licensed Medical Physician and Surgeon
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