Left dural carotid cavernous fistula mimicking an inflammatory process: A case report
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Published on: September 25, 2009
Annika K Oie1, Amanda A Herrmann1, Michael H Rosenbloom1
1HealthPartners Institute, 8170 33rd Ave St, Bloomington, MN 55425, USA.
Abstract:
A female in her 70s presented with altered mental status, left eye pain, ophthalmalgia, and diplopia following a fall. Brain MRI demonstrated contrast-enhancing left peri-insular T2 hyperintense changes that was read as possible herpes simplex encephalitis by neuroradiology. Cerebral angiogram revealed a Barrow Type D left sided carotid cavernous fistula. The patient was subsequently treated with endovascular transvenous coil embolization of the left cavernous sinus resulting in complete occlusion of the fistula. The goal of this case is to present a unique case of a carotid cavernous fistula radiologically mimicking herpes simplex encephalitis. Early recognition of carotid cavernous fistula on neuroimaging is important for prompt treatment of symptoms.
Insights
A rare carotid cavernous fistula mimicked herpes simplex encephalitis in an elderly woman after a fall. Prompt neuroimaging recognition led to successful endovascular embolization, resolving her symptoms.
Area of Science:
- Neurology
- Radiology
- Vascular Surgery
Background:
- Carotid cavernous fistulas (CCFs) are abnormal connections between the carotid artery and cavernous sinus.
- Herpes simplex encephalitis (HSE) is a severe brain infection often presenting with altered mental status and neurological deficits.
Observation:
- An elderly female presented with altered mental status, eye pain, and diplopia post-fall.
- Brain MRI revealed findings suggestive of herpes simplex encephalitis.
- Cerebral angiography identified a Barrow Type D left carotid cavernous fistula.
Findings:
- The patient underwent successful endovascular transvenous coil embolization of the left cavernous sinus.
- Complete occlusion of the carotid cavernous fistula was achieved.
- Symptoms resolved following treatment.
Implications:
- This case highlights the importance of considering carotid cavernous fistula in the differential diagnosis of neurological symptoms mimicking infections like HSE.
- Early and accurate neuroimaging diagnosis of CCF is crucial for timely intervention and favorable patient outcomes.
- Endovascular embolization is an effective treatment for carotid cavernous fistulas.
