Orbitofrontal Extradural Hematoma: Unusual Cause of Proptosis

Traumatic orbital subperiosteal hematoma are a distinct entity and should not be confused with orbital extradural hematoma. Most of the orbital subperiosteal hematoma are small in volume and resolve spontaneously. Management should be based on the clinico-radiological condition. A delayed proptosis may be simply due to orbital venous congestion due to a substantial hematoma or due to a carotid-cavernous fistula. Differentiation between the two is paramount to decide management strategy.

Abstract 1122‐000197: Carotid‐Cavernous Fistula: Does Transcranial Duplex Worth Revisiting?

Introduction : Carotid‐cavernous fistula (CCF) represents a well‐known multifaceted diagnostic challenge starting from clinical presentation till angiography. This case presentation and literature review shed the light on the value of a bedside transcranial duplex (TCD) as a timely and a plausible screening tool. Methods : A case presentation and a brief literature review of CCF diagnosed via transcranial temporal window and made time to angiography shorter than the MRI brain. A review of literature was conducted for the timely diagnostic role of transtemporal TCD compared to transorbital US and an MRI brain. Results : Our case report showed the valuable role of the bedside TCD in diagnosing CCF. There is a limited number of studies which tackled the timely diagnostic role of transtemporal TCD compared to transorbital US and an MRI brain from door to angiography. Conclusions : A large‐sampled randomized controlled trial is needed for evaluating the actual utility of a bed side time and cost‐effective Transtemporal TCD vs other state‐of‐art non‐angiographic diagnostic modalities such as MRI, CT and transorbital US.

Use of coronary stent grafts for the treatment of high-flow carotid cavernous fistula

Carotid cavernous fistulas are abnormal communications between the carotid artery or its branches and the cavernous sinus. It can be traumatic or spontaneous. The widely accepted treatment is by detachable balloons. Advancements in the field of endovascular medicine made available other options for the treatment of this condition. Covered stents are widely available and offer preservation of the parent artery while occluding the fistula.

Analysis of Early Neuroimaging Results in Patients with Acute Isolated Ocular Motor Nerve Palsy

Purpose: To evaluate the efficacy of early neuroimaging in patients with acute isolated 3rd, 4th, and 6th nerve palsy.Methods: Neuroimaging tests were performed in patients >50 years old with acute isolated 3rd, 4th, and 6th nerve palsy. The frequencies and types of abnormal findings were evaluated. All patients were divided into ischemic and non-ischemic groups and differences in clinical characteristics between groups were analyzed.Results: Of the 55 patients, nine (16.4%) had abnormal findings on brain imaging. Among 26 patients with 6th nerve palsy, four (15.4%) were found to have a cause including brain tumor, cerebrovascular compression, carotid cavernous fistula. Superior oblique muscle atrophy was found in two of 19 patients (10.5%) with 4th nerve palsy. Three of 10 patients (30%) with 3rd nerve palsy had abnormal findings and there were cases of pituitary apoplexy, posterior communicating, and cerebrovascular compression.Conclusions: In patients with acute isolated oculomotor paralysis, early neuroimaging tests play an important role in differential diagnosis and evaluation of causes that may lead to mortality.