Ocular ischaemic syndrome following coil embolisation for direct carotid cavernous fistula

A 36-year-old man presented with proptosis and external ophthalmoplegia of the left globe following road traffic injury. Cerebral angiogram revealed moderate flow direct carotid cavernous fistula on left side for which coil embolisation was done repeatedly. Subsequently, the patient developed decreased vision in left eye and developed features of left-sided ocular ischaemic syndrome. The patient was treated conservatively with spontaneous reversal of ocular ischaemic syndrome and complete regain of visual function.

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Dural carotid cavernous fistula following hypertensive emergency

BMJ Case Reports ◽

10.1136/bcr-2019-230823 ◽

2019 ◽

Vol 12 (9) ◽

pp. e230823

Author(s):

Geoffrey Law ◽

Gavin Docherty

Keyword(s):

Vision Loss ◽

Venous Drainage ◽

Hypertensive Emergency ◽

Visual Recovery ◽

Superior Ophthalmic Vein ◽

Coil Embolisation ◽

Carotid Cavernous Fistula ◽

Cerebral Angiogram ◽

Cavernous Fistula ◽

Type D

A 58-year-old woman was referred to the outpatient ophthalmology clinic with progressive bilateral eye redness and vision loss. She had presented 2 weeks earlier with an episode of hypertensive emergency. CT angiography revealed bilateral superior ophthalmic vein (SOV) dilation, prompting further workup with a cerebral angiogram. Subsequent imaging revealed an indirect (type D) carotid-cavernous fistula (CCF) with venous drainage into both SOVs and cavernous sinuses. Successful treatment of the CCF with coil embolisation required interdisciplinary teamwork between ophthalmologists and interventional neuroradiologists. The patient made a substantial visual recovery following treatment.

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Carotid-Cavernous Fistula: An Uncommon and Easily Missed Complication of Head Trauma

Hong Kong Journal of Emergency Medicine ◽

10.1177/102490790501200211 ◽

2005 ◽

Vol 12 (2) ◽

pp. 95-98

Author(s):

KH Lau ◽

CP Ng ◽

CH Chung

Keyword(s):

Head Injury ◽

Traffic Accident ◽

Road Traffic ◽

Emergency Physicians ◽

Carotid Cavernous Fistula ◽

Mortality And Morbidity ◽

Cavernous Fistula ◽

The Right ◽

Direct Carotid Cavernous Fistula ◽

Uncommon Complication

A 57-year-old woman attended the emergency department complaining of protrusion of the right eyeball for three days. The history revealed that she had head injury in a road traffic accident about five weeks ago. The accident had caused a fracture of the right angle of the mandible that was fixed internally by the maxillo-facial surgeon. Subsequent angiogram showed a right direct carotid-cavernous fistula. Endovascular therapy was successful in obliterating the fistula. She recovered well. Although carotid-cavernous fistula is an uncommon complication of head injury, emergency physicians should be aware of this condition because of its potential mortality and morbidity.

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Spontaneous direct carotid-cavernous sinus fistula secondary to a persistent primitive trigeminal artery treated by trans-venous coil embolisation

Interventional Neuroradiology ◽

10.1177/1591019918774241 ◽

2018 ◽

Vol 24 (5) ◽

pp. 567-570 ◽

Cited By ~ 1

Author(s):

Andrew Imrie ◽

Kendal Redmond ◽

David Leggett

Keyword(s):

Cavernous Sinus ◽

Trigeminal Artery ◽

Coil Embolisation ◽

Carotid Cavernous Fistula ◽

Cavernous Fistula ◽

Persistent Primitive Trigeminal Artery ◽

History Of ◽

Carotid Cavernous Sinus Fistula ◽

Primitive Trigeminal Artery ◽

Direct Carotid Cavernous Fistula

A healthy 51-year-old female presented with a spontaneous direct carotid-cavernous sinus fistula associated with a persistent primitive trigeminal artery. She had no history of connective tissue or cerebrovascular disorders or significant head trauma. This is a rare lesion with only 18 previously reported cases. It had similar clinical presentation and imaging appearance to a high-flow direct carotid-cavernous fistula and was uncovered after successful trans-venous coil embolisation of the fistula. It therefore needs to be considered in cases of direct carotid-cavernous fistula without history of trauma. Knowledge of types of persistent primitive trigeminal artery is also important for their critical treatment implications.

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