Carotid cavernous fistula: A rare but treatable cause of ophthalmoplegia - A case report
Carotid cavernous fistulas (CCFs) are a rare but debilitating entity that may present with orbital or cerebral venous hypertension. CCFs may pose diagnostic and management pitfalls for clinicians as they can initially be misdiagnosed as primary orbital pathology or nonarteriovenous shunting-related...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2023-01-01
|
| Series: | Brain Circulation |
| Subjects: | |
| Online Access: | http://www.braincirculation.org/article.asp?issn=2394-8108;year=2023;volume=9;issue=1;spage=30;epage=34;aulast=Krothapalli |
| _version_ | 1797824457939615744 |
|---|---|
| author | Neeharika Krothapalli Mohamad Fayad Eric Sussman Charles Bruno Martin Ollenschleger Tapan Mehta |
| author_facet | Neeharika Krothapalli Mohamad Fayad Eric Sussman Charles Bruno Martin Ollenschleger Tapan Mehta |
| author_sort | Neeharika Krothapalli |
| collection | DOAJ |
| description | Carotid cavernous fistulas (CCFs) are a rare but debilitating entity that may present with orbital or cerebral venous hypertension. CCFs may pose diagnostic and management pitfalls for clinicians as they can initially be misdiagnosed as primary orbital pathology or nonarteriovenous shunting-related cavernous sinus pathology. Furthermore, the resolution of pulsatile tinnitus could be an ominous sign in patients with untreated dural arteriovenous fistula. We describe a case of a 56-year-old male who presented with progressive right eye proptosis, congestion, decreased visual acuity, limited duction, exophthalmos, and pulsatile tinnitus. The patient had poor response to antibiotics and steroids. Magnetic resonance imaging brain showed significant inflammation involving the right orbit and atypical enhancement of the basal frontal lobe adjacent to the orbit. Cerebral angiography revealed an indirect right CCF and right sigmoid sinus thrombosis with stenosis of the right internal jugular vein. No clear predisposing factor was identified. Given the rapidly progressive nature of the condition, the patient successfully underwent endovascular treatment with transvenous approach to preserve flow in the internal carotid artery while ensuring occlusion of the fistula. A triad of proptosis, eye congestion, and signs of turbulent flow such as tinnitus or orbital bruit should raise suspicion for CCF. An interesting feature in this patient is that CCF may have occurred secondary to sigmoid sinus thrombosis with accompanying small cortical vein drainage. Our case highlights the importance of early recognition and timely intervention to ensure the resolution of orbital hypertension-related symptoms in rare cases of CCFs. |
| first_indexed | 2024-03-13T10:39:16Z |
| format | Article |
| id | doaj.art-af487eefa401440d9695e9fcffc8262a |
| institution | Directory Open Access Journal |
| issn | 2455-4626 |
| language | English |
| last_indexed | 2024-03-13T10:39:16Z |
| publishDate | 2023-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Brain Circulation |
| spelling | doaj.art-af487eefa401440d9695e9fcffc8262a2023-05-18T05:05:50ZengWolters Kluwer Medknow PublicationsBrain Circulation2455-46262023-01-0191303410.4103/bc.bc_64_22Carotid cavernous fistula: A rare but treatable cause of ophthalmoplegia - A case reportNeeharika KrothapalliMohamad FayadEric SussmanCharles BrunoMartin OllenschlegerTapan MehtaCarotid cavernous fistulas (CCFs) are a rare but debilitating entity that may present with orbital or cerebral venous hypertension. CCFs may pose diagnostic and management pitfalls for clinicians as they can initially be misdiagnosed as primary orbital pathology or nonarteriovenous shunting-related cavernous sinus pathology. Furthermore, the resolution of pulsatile tinnitus could be an ominous sign in patients with untreated dural arteriovenous fistula. We describe a case of a 56-year-old male who presented with progressive right eye proptosis, congestion, decreased visual acuity, limited duction, exophthalmos, and pulsatile tinnitus. The patient had poor response to antibiotics and steroids. Magnetic resonance imaging brain showed significant inflammation involving the right orbit and atypical enhancement of the basal frontal lobe adjacent to the orbit. Cerebral angiography revealed an indirect right CCF and right sigmoid sinus thrombosis with stenosis of the right internal jugular vein. No clear predisposing factor was identified. Given the rapidly progressive nature of the condition, the patient successfully underwent endovascular treatment with transvenous approach to preserve flow in the internal carotid artery while ensuring occlusion of the fistula. A triad of proptosis, eye congestion, and signs of turbulent flow such as tinnitus or orbital bruit should raise suspicion for CCF. An interesting feature in this patient is that CCF may have occurred secondary to sigmoid sinus thrombosis with accompanying small cortical vein drainage. Our case highlights the importance of early recognition and timely intervention to ensure the resolution of orbital hypertension-related symptoms in rare cases of CCFs.http://www.braincirculation.org/article.asp?issn=2394-8108;year=2023;volume=9;issue=1;spage=30;epage=34;aulast=Krothapallicarotid cavernous fistulaembolizationophthalmoplegia |
| spellingShingle | Neeharika Krothapalli Mohamad Fayad Eric Sussman Charles Bruno Martin Ollenschleger Tapan Mehta Carotid cavernous fistula: A rare but treatable cause of ophthalmoplegia - A case report Brain Circulation carotid cavernous fistula embolization ophthalmoplegia |
| title | Carotid cavernous fistula: A rare but treatable cause of ophthalmoplegia - A case report |
| title_full | Carotid cavernous fistula: A rare but treatable cause of ophthalmoplegia - A case report |
| title_fullStr | Carotid cavernous fistula: A rare but treatable cause of ophthalmoplegia - A case report |
| title_full_unstemmed | Carotid cavernous fistula: A rare but treatable cause of ophthalmoplegia - A case report |
| title_short | Carotid cavernous fistula: A rare but treatable cause of ophthalmoplegia - A case report |
| title_sort | carotid cavernous fistula a rare but treatable cause of ophthalmoplegia a case report |
| topic | carotid cavernous fistula embolization ophthalmoplegia |
| url | http://www.braincirculation.org/article.asp?issn=2394-8108;year=2023;volume=9;issue=1;spage=30;epage=34;aulast=Krothapalli |
| work_keys_str_mv | AT neeharikakrothapalli carotidcavernousfistulaararebuttreatablecauseofophthalmoplegiaacasereport AT mohamadfayad carotidcavernousfistulaararebuttreatablecauseofophthalmoplegiaacasereport AT ericsussman carotidcavernousfistulaararebuttreatablecauseofophthalmoplegiaacasereport AT charlesbruno carotidcavernousfistulaararebuttreatablecauseofophthalmoplegiaacasereport AT martinollenschleger carotidcavernousfistulaararebuttreatablecauseofophthalmoplegiaacasereport AT tapanmehta carotidcavernousfistulaararebuttreatablecauseofophthalmoplegiaacasereport |