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Review
. 2018 Jul 25;18(1):183.
doi: 10.1186/s12886-018-0863-6.

Post-traumatic right carotid-cavernous fistula resulting in symptoms in the contralateral eye: a case report and literature review

Linxin Zhu  1   2 , Bing Liu  1   2 , Jingxiang Zhong  3   4
Affiliations
Review

Post-traumatic right carotid-cavernous fistula resulting in symptoms in the contralateral eye: a case report and literature review

Linxin Zhu et al. BMC Ophthalmol. .

Abstract

Background: To report a case of a carotid-cavernous fistula (CCF) that occurred after a motor vehicle accident and review the uniqueness of this case and the main confusing points for the diagnosis of such cases.

Case presentation: A 22-year-old man complained of left eyelid swelling, eye redness, visual decrease and occasional headache after motor vehicle accident 4 months prior during which he experienced a head injury. He was initially thought to have glaucoma, but he was finally diagnosed with a right CCF based on magnetic resonance imaging (MRI) and digital subtraction angiography (DSA). Timely embolization surgery resulted in obvious relief of the ocular symptoms and an improved prognosis.

Conclusion: This is the first reported case of a post-traumatic unilateral CCF with contralateral symptoms in direct CCF, it is very infrequent and deserves our attention. We should maintain high suspicion of CCF and confirm the diagnosis by DSA when managing such patients to prevent serious consequences. Early diagnosis and treatment can improve the prognosis of patients.

Keywords: CCF; Contralateral; DSA; Trauma.

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Conflict of interest statement

Ethics approval and consent to participate

This study followed the tenets of the Declaration of Helsinki and approved by the Ethics Committee of the First Affiliated Hospital of Jinan University. Written informed consent was obtained from the participant.

Consent for publication

Written informed consent was obtained from the patient for publication of this case and any accompanying images. A copy of written consent is available for review by the Executive Editor of this journal.

Competing interest

The authors declare that they have no competing interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
The appearances of both eyes. The right eye is almost normal, but the left eye exhibits slight eyelid swelling, chemosis, and hyperaemia
Fig. 2
Fig. 2
Slit lamp examination images of the four directions in the left eye revealed corkscrew hyperaemia centred on the cornea
Fig. 3
Fig. 3
Extraocular muscle movement showed limitation on abduction and elevation of the left eye
Fig. 4
Fig. 4
Magnetic resonance imaging (MRI) of the periorbital region. a. It revealed expansion of the left cavernous sinus and dilation of the left superior ophthalmic vein (white arrow). b. It revealed slight thickening of the left lateral rectus muscle and enlarged left cavernous sinus, yet the right was almost normal (white arrow).
Fig. 5
Fig. 5
Digital subtraction angiography (DSA) images. a. Right cerebrovascular (CVA) filling delay (black arrow) and arterial blood traversing the intercavernous sinus resulting in expansion of the contralateral cavern. b. Broadening of the left superior ophthalmic vein (black arrow)
Fig. 6
Fig. 6
Following successful embolization surgery, the exophthalmos, chemosis and hyperaemia of the left eye were significantly relieved. a. The left eye before surgery. b. The left eye after surgery
See this image and copyright information in PMC

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