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Case Reports
. 2015 Dec 24;6(3):482-7.
doi: 10.1159/000443141. eCollection 2015 Sep-Dec.

Unilateral Direct Carotid Cavernous Fistula Causing Bilateral Ocular Manifestation

Zeferino Demartini Jr  1 , Fernando Liebert  1 , Luana Antunes Maranha Gatto  1 , Thiago Simiano Jung  1 , Carlos Rocha Jr  1 , Alex Marques Borges Santos  1 , Gelson Luis Koppe  1
Affiliations
Case Reports

Unilateral Direct Carotid Cavernous Fistula Causing Bilateral Ocular Manifestation

Zeferino Demartini Jr et al. Case Rep Ophthalmol. .

Abstract

Unilateral carotid cavernous fistula presents with ipsilateral ocular findings. Bilateral presentation is only seen in bilateral fistulas, usually associated with indirect (dural) carotid cavernous fistulas. Direct carotid cavernous fistulas are an abnormal communication between the internal carotid artery and the cavernous sinus. They typically begin with a traumatic disruption in the artery wall into the cavernous sinus, presenting with a classic triad of unilateral pulsatile exophthalmos, cranial bruit and episcleral venous engorgement. We report the case of a 38-year-old male with traumatic right carotid cavernous sinus fistula and bilateral ocular presentation successfully treated by interventional neuroradiology.

Keywords: Carotid artery injury; Carotid cavernous sinus fistula; Endovascular procedure; Exophthalmos; Papilledema; Therapeutic embolization.

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Figures

Fig. 1
Fig. 1
a Bilateral proptosis, chemosis and conjunctival injection at admission. b Significant improvement at the 21st postoperative day.
Fig. 2
Fig. 2
a, b Fundus retinography showing bilateral papilledema and retinal hemorrhage. c, d FA showing bilateral venous dilation.
Fig. 3
Fig. 3
a Right internal carotid angiogram (anteroposterior view) showing right carotid cavernous fistula filling contralateral cavernous sinus through the contralateral intercavernous sinus. b Anteroposterior view showing bilateral ectasia of superior ophthalmic veins, occluded with detachable balloon and coils (c).
See this image and copyright information in PMC

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