Résumé
Proptosis due to carotid cavernous fistula is rare sequelae of head injury. We report a case of post-traumatic, direct high flow carotid cavernous fistula that resolved spontaneously 06 weeks after carotid angiography. It however, resulted in loss of vision due to delay in early treatment. In the cases of post-traumatic proptosis, carotid cavernous fistula should be kept in mind
Sujets)
Humains , Femelle , Adulte , Fistule carotidocaverneuse/étiologie , Lésions traumatiques de l'artère carotide , Exophtalmie/étiologie , Traumatismes cranioencéphaliquesRésumé
Carotid cavernous fistulas are a rare entity occurring as result of head trauma and also spontaneously. The authors report a rare case of central retinal artery occlusion complicating traumatic carotid-cavernous fistula, resulting in severe visual acuity loss. Spontaneous closure of the fistula was observed. The possible mechanisms responsible for this complication are discussed.
Fístulas carótido-cavernosas são raras e ocorrem como resultado de trauma cefálico e também espontaneamente. Os autores relatam um caso raro de oclusão de artéria central da retina complicando fístula carótido-cavernosa traumática, resultando em perda grave da acuidade visual. Fechamento espontâneo da fístula foi observado. Os possíveis mecanismos responsáveis por esta complicação são discutidos.
Sujets)
Adulte , Humains , Mâle , Fistule carotidocaverneuse/étiologie , Traumatismes crâniens fermés/complications , Occlusion artérielle rétinienne/étiologie , Fistule carotidocaverneuse , Angiographie fluorescéinique , Occlusion artérielle rétinienne/anatomopathologie , Tomodensitométrie , Acuité visuelle/physiologieRésumé
In this report, we present a rare case of traumatic carotid cavernous fistula that was occluded during the interventional procedure by incidentally formed blood clot. Sudden occlusion of the fistula and the resolution process of the precarious blood clot can be clearly seen on the serial angiogram.
Sujets)
Mâle , Humains , Adulte , Procédures de chirurgie vasculaire/effets indésirables , Résultat thérapeutique , Résultats fortuits , Traumatismes cranioencéphaliques/complications , Fistule carotidocaverneuse/étiologie , Thrombose carotidienne/étiologieRésumé
Objetivo: Enfatizar la importancia del diagnóstico clínico y del tratamiento oportuno de las fístulas del seno cavernoso que se manifiestan anterógradamente en la órbita. Pacientes y Métodos: Se presentan dos pacientes atendidos en el Servicio de Oftalmología del Hospital Salvador, tratados endovascularmente en el Instituto de Neurocirugía, quienes presentaron una evolución visual muy disímil (uno llegó a la ceguera y el otro recuperó en 100 por ciento de visión) debido a las diferencias en el tiempo de diagnóstico e inicio del tratamiento. Discusión: Se discuten las diferencias en la expresión clínica de los adversos tipos de fístulas (de bajo y alto flujo), el diagnóstico diferencial y la importancia del tratamiento oportuno para lograr un resultado anatómico y funcional óptimo del ojo afectado.
Sujets)
Humains , Mâle , Femelle , Adulte , Sujet âgé , Cécité/prévention et contrôle , Exophtalmie/diagnostic , Exophtalmie/étiologie , Exophtalmie/rééducation et réadaptation , Fistule carotidocaverneuse/complications , Fistule carotidocaverneuse/thérapie , Angiographie , Hormones corticosurrénaliennes/usage thérapeutique , Diagnostic différentiel , Fistule carotidocaverneuse/étiologie , Facteurs de risqueRésumé
We present two cases of carotid injury during transsphenoidal surgery for pituitary adenoma. While in one of the cases it resulted in the formation of a false aneurysm of cavernous carotid artery, in the other patient, a carotid cavernous fistula (CCF) formed. The false aneurysm was managed by surgical trapping and the patient had an uneventful recovery. The CCF was initially managed with balloon embolization. The balloon got deflated and resulted in a false aneurysm with persistent CCF. This was occluded with Guglielmi Detachable Coils (GDC). The management options are discussed and relevant literature is reviewed. We emphasize the importance of an early cerebral angiography to know the status of the injured carotid artery and formation of false aneurysm / fistula.
Sujets)
Adénomes/chirurgie , Adulte , Faux anévrisme/étiologie , Artère carotide interne/anatomopathologie , Fistule carotidocaverneuse/étiologie , Angiographie cérébrale , Humains , Mâle , Tumeurs de l'hypophyse/chirurgie , Complications postopératoires , Os sphénoïde/chirurgie , TomodensitométrieRésumé
A fístula carótido-cavernosa é uma comunicaçäo patológica entre a artéria carótida interna e o seio cavernoso. Apresentamos o caso de um paciente de 32 anos de idade com fístula carótido-cavernosa devida a traumatismo crânio-encefálico. O tratamento preconizado é a embolizaçäo mas neste caso em especial houve falha devido às características próprias da fístula, e o paciente progrediu de maneira desfavorável evoluindo ao óbito por epistaxe incontrolável