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Post-traumatic carotid-cavernous fistula with bilateral proptosis simulating cavernous sinus thrombosis
Nirupama Kasturi1, Pooja Kumari1, Gayatri Nagarajan1
1Ophthalmology, JIPMER, Puducherry, India.
BMJ Case Reports
|April 3, 2019
Summary
A direct carotid-cavernous fistula (CCF) caused by blunt orbital trauma led to vision loss and proptosis. Coil embolization successfully treated the CCF, resolving symptoms and improving eye movement.
Area of Science:
- Ophthalmology
- Neurology
- Vascular Surgery
Background:
- Blunt orbital trauma can lead to serious vascular complications.
- Carotid-cavernous fistulas (CCFs) are abnormal connections between the carotid artery and the cavernous sinus.
- Prompt diagnosis and intervention are crucial for preserving vision and neurological function.
Observation:
- A 48-year-old woman presented with bilateral proptosis, ophthalmoplegia, fever, and vision loss post-trauma.
- Initial diagnosis of cavernous sinus thrombosis was unresponsive to antibiotics.
- A subtle bruit and digital subtraction angiography confirmed a direct (type A) carotid-cavernous fistula.
Findings:
- Direct carotid-cavernous fistula (CCF) secondary to blunt orbital trauma.
- Successful treatment of CCF via right coil embolization.
- Complete resolution of proptosis and significant improvement in extraocular movements at 4-month follow-up.
Implications:
- Highlights the importance of considering CCF in orbital trauma cases with unusual presentations.
- Demonstrates the efficacy of endovascular embolization for direct CCFs.
- Emphasizes the potential for visual and functional recovery with timely intervention.
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