J Korean Ophthalmol Soc.  2000 Mar;41(3):793-800.

Spontaneous Dural Carotid-C avernous Sinus Fistula: A Case Report

• Kim IT
• Choi JB
• Lee SM

Abstract

The case reported here, concerns a spontaneous low-flow fistula between the carotid arterial network and the cavernous sinus, with ophthalmological symptoms such as conjunctival congestion and diplopia in a 41-year-old woman. The patient has suffered from diabetes without trauma history. Patient's ocular symptoms and signs were only present in the left eye with best-corrected visual acuity 0.04 at the time of presentation. Other ophthalmic findings were exophthalmos, elevated intraocular pressure, and visual field defects. Enlarged extraocular muscles and proptosis were found on orbital computed tomography leading to the misdiagnosis of orbial pseudotumor or thyroid rbitopathy. Carotid angiography showed dural carotid-cavernous sinus fistula, which involved left-side internal and external carotid arterial network and right-side internal carotid arterial network. Orbital color Doppler imaging showed a flow reversal with a systolic component in the enlarged superior ophthalmic vein. We were able to diagnose dural carotid-cavernous sinus fistula. Dural carotid-cavernous sinus fistula was closed successfully by embolization via the vein without omplication. The visual acuity, proptosis, and dilated and tortuous vessels of the conjunctiva improved.

Keyword

Carotid angiography; Color Doppler imaging; Dural carotid-cavernous sinus fistula; Embolization

MeSH Terms

Adult
Angiography
Carotid-Cavernous Sinus Fistula
Cavernous Sinus
Conjunctiva
Diagnostic Errors
Diplopia
Estrogens, Conjugated (USP)
Exophthalmos
Female
Fistula*
Humans
Intraocular Pressure
Muscles
Orbit
Thyroid Gland
Veins
Visual Acuity
Visual Fields
Estrogens, Conjugated (USP)