[Neuro-ophthalmologic multiple lesions in craniocerebral trauma]

The authors present the case of a child, 8 years old, victim of a car accident, suffering a cranio-cerebral trauma. The posttraumatic injuries were: bitemporal cranial fractures, LE VI nerve palsy with secondary convergent strabismus, left posttraumatic optic neuropathy with poor vision, right deafness, nasal bone fracture, left paramedian mandibular fracture. Four months later the child developed proptosis due to a high-flow carotid-cavernous fistula, on the site of the good eye, RE, which was clinically diagnosed and confirmed by the results of MRI, MRA and cerebral angiography. Considering the ophthalmologic and neurologic risks of this pathologic condition, the surgery was performed, using an external device (Silverstone clamp) with the purpose of progressive and adjustable control of the fistula thrombosis. The postoperative result was fistula thrombosis, preserving the visual acuity and visual field, with a residual hypertonia on the right eye. The peculiarity of the case consist in the small age of the patient and the severity of neuro-ophthalmologic lesions. The child will live for the rest of his life with a single well-seeing eye, whose function could be at risk at any moment, related to the posttraumatic vascular changes at the level of the right cavernous sinus.