A 32-year-old man with delayed onset post-traumatic proptosis and diplopia
Benjamin P Erickson1, Thomas E Johnson1
1Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida.
The Journal of Emergency Medicine
|February 6, 2014
Summary
Traumatic carotid cavernous fistula (CCF) can cause proptosis and vision loss after head trauma. Prompt diagnosis and treatment with embolization and covered stents can restore vision and prevent serious complications.
Area of Science:
- Ophthalmology
- Neurology
- Radiology
Background:
- Proptosis and ocular motility deficits following craniofacial trauma may signify vision-threatening or life-threatening conditions.
- Early recognition of traumatic carotid cavernous fistula (CCF) is crucial to prevent severe sequelae.
Observation:
- A 32-year-old male presented with proptosis, motility deficits, and decreased vision one month post-motor vehicle accident.
- Physical examination revealed an orbital bruit.
- Four-vessel angiography confirmed a carotid cavernous fistula (CCF).
Findings:
- The patient underwent treatment with covered stents and an embolic agent to occlude the arteriovenous communication.
- The intervention successfully abolished the CCF, leading to rapid recovery.
Implications:
- Traumatic CCF is a rare but significant complication of craniofacial injuries.
- Suspicion should be high in trauma patients with exophthalmos, arterialized conjunctival vessels, and orbital bruit.
- Timely diagnosis and management are essential to minimize morbidity and preserve vision.
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