[Diagnostic and therapeutic problems of bilateral carotid-cavernous sinus fistula]
Insights
Carotid-cavernous sinus fistula involves abnormal connections to the cavernous sinus. This case highlights a rare bilateral presentation with an atypical clinical picture, challenging diagnosis.
Area of Science:
- Vascular Neurology
- Ophthalmology
- Radiology
Background:
- Carotid-cavernous sinus fistula (CCF) is an abnormal vascular connection between the carotid arteries and the cavernous sinus.
- CCF can be spontaneous or post-traumatic, with Type-A (direct CCF) being the most common and presenting with Dandy's triad.
- Indirect CCFs are less common, often presenting with atypical symptoms, complicating diagnosis.
Observation:
- This case report details a rare instance of bilateral carotid-cavernous sinus fistula.
- The fistula was supplied by numerous arteries, contributing to an unusual clinical presentation.
- The patient exhibited an atypical clinical picture, diverging from the classic Dandy's triad.
Findings:
- The bilateral nature and multiple arterial supply of the CCF presented diagnostic challenges.
- Atypical symptoms in indirect CCFs can mimic other orbital pathologies, delaying diagnosis.
- Advanced imaging was crucial in identifying the complex vascular anatomy.
Implications:
- Highlights the importance of considering rare variations in CCF presentation, especially bilateral cases.
- Emphasizes the need for high clinical suspicion and comprehensive diagnostic workup for atypical orbital symptoms.
- Contributes to understanding the diverse clinical manifestations and diagnostic complexities of carotid-cavernous sinus fistulas.
Abstract:
Carotid-cavernous sinus fistula is an abnormal connection between the internal carotid artery, external one or their meningeal branches and the sinus cavernous. It can be the spontaneous or post-traumatic pathology. The main clinical syndrome is Dandy's triad: pulsating exophthalmia, chemosis, bruit in the region of orbit. These syndromes appear in the case of the most frequent direct carotid-cavernous sinus fistula (type-A in Barrow classification). Indirect carotid-cavernous sinus fistulas are significantly more uncommon and the symptoms can be atypical and less intensive. It makes difficulties in establishing the right diagnosis. The case report concerns the occurrence of bilateral carotid-cavernous sinus fistula, supplying by numerous arteries, with atypical clinical picture.