Article Text
Statistics from Altmetric.com
A man in his late fifties had right-sided retro-orbital pain and diplopia for 1 month. There was no preceding head trauma. On examination, he had a right abducens palsy with subtle bilateral chemosis and proptosis, but no ocular bruit. The visual acuities were 6/9 on the right and 6/6 on the left whereas pupils, funduscopy, visual fields by confrontation, colour vision and intraocular pressures (right 15 mm Hg, left 20 mm Hg) were normal bilaterally. MR scan of brain (T2-weighted images) showed bilaterally abnormal flow voids in the cavernous sinuses, with enlargement of the cavernous sinuses, right superior ophthalmic vein and left spheno-parietal sinus (figure 1A,B). Follow-up MR imaging with time-of-flight MR cerebral angiography showed abnormal flow signals in these venous structures, indicating a carotid-cavernous fistula (figure 1D). Digital cerebral angiogram confirmed bilateral indirect carotid-cavernous fistulae (barrow type D, see below) with retrograde cortical venous reflux (figure 2), which were successfully treated with endovascular embolisation.
Footnotes
Contributors TT: literature search, drafting and critical revision of the manuscript. JM: image selection, critical revision of the manuscript. SA: image selection, critical revision of the manuscript. US: study concept and design, literature search, critical revision of the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests US has received travel and speaker honoraria from Eisai Australia and LivaNova Australia.
Provenance and peer review Not commissioned; externally peer reviewed by Iain McGurgan, Oxford, UK.
Read the full text or download the PDF:
Other content recommended for you
- Multimodal endovascular therapy of traumatic and spontaneous carotid cavernous fistula using coils, n-BCA, Onyx and stent graft
- Mid- and long-term outcomes of carotid-cavernous fistula endovascular management with Onyx and n-BCA: experience of a single tertiary center
- Endovascular repair of direct carotid–cavernous fistula in Ehlers–Danlos type IV
- Endovascular repair of direct carotid–cavernous fistula in Ehlers–Danlos type IV
- Indirect carotid cavernous fistula mimicking ocular myasthenia
- Direct puncture of the highest cervical segment of the internal carotid artery for treatment of an iatrogenic carotid cavernous fistula in a patient with Ehlers-Danlos syndrome
- Direct puncture of the superior ophthalmic vein for carotid cavernous fistulas: a 21-year experience
- Embolization of a cavernous carotid fistula through the vein of Labbé: a new alternative transvenous access route
- Dural carotid cavernous fistula following hypertensive emergency
- Recurrence risk factors in detachable balloon embolization of traumatic direct carotid cavernous fistulas in 188 patients