J Korean Med Sci.  2005 Feb;20(1):166-168. 10.3346/jkms.2005.20.1.166.

Spontaneous Intracerebral Hematoma from Transient Occult Carotid-cavernous Fistula: A Case Report

• Moon KY
• Kang SD

• KMID: 1781748
• DOI: http://doi.org/10.3346/jkms.2005.20.1.166

Abstract

After the spontaneous relief of initial symptoms by traumatic carotid-cavernous fistula (CCF), paradoxical worsening of patient's condition can be followed. We present a case of a 60-yr-old man whose audible bruit from a traumatic CCF had completely disappeared. A few days later, however, the patient had spontaneous intracerebral hematoma with cortical venous drainage. Complete obliteration of the fistula was achieved after embolization. When initial audible bruit in traumatic CCF disappears suddenly, cerebral angiography should be performed to differentiate venous hypertension by the hemodynamic changes of the cavernous sinus channels from spontaneous resolution of CCF.

Keyword

Carotid-Cavernous Sinus Fistula; Cerebral Hemorrhage; Cerebral Angiography

MeSH Terms

Brain/pathology
Carotid Arteries/pathology
Carotid-Cavernous Sinus Fistula/*complications/*pathology/therapy
Cerebral Angiography/methods
Cerebral Hemorrhage, Traumatic/*etiology/therapy
Humans
Male
Middle Aged
Research Support, Non-U.S. Gov't
Tomography, X-Ray Computed/methods

Figure

• 

  Fig. 1 T2-weighted axial and sagittal magnetic resonance images show a dilated superior ophthalmic vein (arrows).

• 

  Fig. 2 Non contrast-enhanced computed tomography scan shows a large amount of hematoma in the left frontal base.

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  Fig. 3 Left internal carotid artery angiogram in lateral projection, showing direct CCF with drainage into sigmoid sinus (short arrow), superior ophthalmic vein (long arrow) and inferior ophthalmic vein (arrowhead), and dilated subfrontal pial veins (open arrow).

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  Fig. 4 Follow-up angiogram after the transarterial embolization shows a complete occlusion of CCF.

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