关键词: carotid-cavernous sinus fistula case report digital subtraction angiography(dsa) endovascular embolisation indirect neuro radiology neuro-ophthalmic manifestations neuro-psychiatric

来  源:   DOI:10.7759/cureus.37523   PDF(Pubmed)

Abstract:
Carotid-cavernous fistula (CCF) is a rare sight and potentially life-threatening disorder arising from an abnormal connection between the carotid artery and the cavernous sinus. It can be classified into direct or indirect according to different arteriovenous shunts. Direct CCF usually has dramatic ocular presentations, whereas indirect CCF has a more insidious course and may be associated with neurologic symptoms in posteriorly draining fistulas. A 61-year-old gentleman presented with five days history of altered behavior and double vision preceding a bulging left eye. Ocular examination showed left eye proptosis, generalized chemosis, total ophthalmoplegia, and raised intra-ocular pressure. Computed tomography angiography (CTA) brain and orbit demonstrated dilated superior ophthalmic vein (SOV) with communication to a tortuous cavernous sinus suggestive of carotid-cavernous fistula (CCF). Digital subtraction angiography (DSA) eventually confirmed the presence of indirect communication between branches of the bilateral external carotid artery (ECA) and left cavernous sinus, which is a type C indirect CCF according to the Barrow classification. Total embolization of left CCF was successfully achieved via transvenous access. A marked reduction of proptosis and intra-ocular pressure was noted following the procedure. Although rare, neuropsychiatric presentation could be a possible presentation of CCF, and treating physicians should be aware of it. A high index of suspicion and prompt diagnosis is crucial in managing this sight and life-threatening condition. Early intervention can improve the prognosis of patients.
摘要:
颈动脉海绵窦瘘(CCF)是一种罕见的视力和潜在的威胁生命的疾病,由颈动脉和海绵窦之间的异常连接引起。根据动静脉分流的不同,可分为直接或间接。直接CCF通常具有戏剧性的眼部表现,而间接CCF的病程更阴险,可能与后引流瘘的神经系统症状有关。一位61岁的绅士在左眼凸出之前表现出五天的行为改变和复视史。眼部检查显示左眼眼球突出,全身性放化疗,全眼肌麻痹,提高了眼内压.计算机断层扫描血管造影(CTA)脑和眼眶显示眼上静脉(SOV)扩张,与曲折的海绵窦连通,提示颈动脉海绵窦瘘(CCF)。数字减影血管造影(DSA)最终证实双侧颈外动脉(ECA)分支与左海绵窦之间存在间接连通,根据巴罗分类,这是一种C型间接CCF。通过经静脉途径成功实现左CCF的完全栓塞。手术后,眼球突出和眼内压显着降低。虽然罕见,神经精神病学表现可能是CCF的可能表现,治疗医生应该意识到这一点。高度怀疑和及时诊断对于控制这种视力和危及生命的状况至关重要。早期干预可改善患者预后。
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