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Indirect carotid cavernous fistula presenting as pulsatile tinnitus
1Department of Otolaryngology, North Manchester General Hospital, Manchester, UK.
The Journal of Laryngology and Otology
|December 29, 2000
Summary
A spontaneous carotid cavernous fistula caused pulsatile tinnitus and ptosis. This rare condition, potentially arising from silent cavernous sinus thrombosis, requires careful diagnosis and management.
Area of Science:
- Neurology
- Ophthalmology
- Vascular Surgery
Background:
- Carotid cavernous fistulas (CCFs) are abnormal connections between the carotid artery and the cavernous sinus.
- Indirect CCFs, often spontaneous, can present with varied neurological and ophthalmological symptoms.
- Pulsatile tinnitus is a key, though sometimes overlooked, symptom requiring thorough investigation.
Observation:
- A case of spontaneous indirect carotid cavernous fistula is presented.
- The patient exhibited pulsatile tinnitus, left-sided temporal headache, and left-sided ptosis.
- Clinically silent cavernous sinus thrombosis was identified as the underlying cause.
Findings:
- Magnetic resonance imaging angiography confirmed the diagnosis of indirect carotid cavernous fistula.
- The study highlights the link between silent cavernous sinus thrombosis and spontaneous indirect CCFs.
- Pulsatile tinnitus served as a significant presenting symptom.
Implications:
- This case underscores the importance of investigating pulsatile tinnitus for potential CCF.
- Early diagnosis through advanced imaging like MRA is crucial.
- Management strategies for indirect CCFs range from conservative observation to endovascular intervention.