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Left dural to right cavernous sinus fistula. A case report
T J Martin1, B T Troost, L E Ginsberg
1Department of Ophthalmology, Bowman Gray School of Medicine, Wake Forest University Eye Center, Winston-Salem, North Carolina 27157-1033, USA.
Summary
This case study highlights a rare dural-cavernous sinus fistula presenting with symptoms opposite the arterial source. It emphasizes the need for bilateral angiography to accurately diagnose these complex arteriovenous malformations.
Area of Science:
- Neurology
- Vascular Surgery
- Ophthalmology
Background:
- Direct carotid-cavernous sinus fistulas (CCSFs) can manifest with symptoms contralateral to the arterial supply.
- Accurate diagnosis is crucial for effective management.
Observation:
- A patient presented with right eye proptosis, redness, and transient diplopia.
- Initial MRI and unilateral carotid angiography were inconclusive.
- Left-sided carotid angiography revealed a dural-CCSF with left external carotid artery shunting to the right cavernous sinus.
Findings:
- The fistula exclusively caused symptoms contralateral to its arterial source.
- Orbital duplex sonography confirmed reverse flow in the superior ophthalmic vein.
- This case demonstrates an unusual presentation of a dural-CCSF.
Implications:
- This unusual presentation offers insights into the pathophysiology of cavernous sinus arteriovenous fistulas.
- Bilateral carotid angiography is essential for comprehensive characterization of CCSFs.
- Highlights the importance of considering contralateral symptoms in CCSF diagnosis.