spontaneous Resolution of Direct Carotid Cavernous Fistula

Abstract

Proptosis due to carotid cavernous fistula is rare sequelae of head injury. We report a case of post-traumatic, direct high flow carotid cavernous fistula that resolved spontaneously 06 weeks after carotid angiography. It however, resulted in loss of vision due to delay in early treatment. In the cases of post-traumatic proptosis, carotid cavernous fistula should be kept in mind.

Case Details

Disease Location

Heart

Personal Characteristics

Young female history of left-sided ptosis, swelling of both upper and lower lids, temporal headache and ear bleed. There was no previous history of any ocular and systemic diseases.

Clinical Characteristics

3 weeks history of head injury, followed by bulging of her left eye, whooshing noises in her head and double vision. Ophthalmic examination on presentation revealed corrected visual acuity of 20/30 in right and 20/40 in left eye. Pe: severe ptosis in left eye, adnexa showed swelling of both upper and lower lids with resistance to retropulsion. Conjunctiva showed chemosis and dilated episcleral blood vessels. Ocular movements were painful. On x-ray of skull lateral view, there was a fracture of the petrous part of the temporal bone. Carotid angiography revealed dilated cavernous sinus and arterialization of superior ophthalmic vein with retrograde flow. The contrast medium from internal carotid artery was seen filling the cavernous sinus through fistula and then flowing retrograde into the superior ophthalmic vein. A diagnosis of left traumatic direct high flow carotid cavernous fistula was made.

Remission Characteristics

Fistula resolved after 6 weeks after carotid angiography

Treatment & Mechanisms

Proposed Remission Mechanisms

Thrombosis of the cavernous sinus

Clinical Treatment

Follow-up carotid angiography intraocular pressure lowering eye drops artificial tears and painkillers.