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Spontaneous Carotid Cavernous Fistula in a Case with Protein S Deficiency that Newly Developed Ophthalmoplegia after Embolization
Journal of Clinical Neurology ; : 164-167, 2011.
Artículo en Inglés | WPRIM | ID: wpr-82459
ABSTRACT

BACKGROUND:

Carotid cavernous fistula (CCF) is an abnormal communication between the carotid artery and the cavernous sinus. The pathogenesis of spontaneous CCF remains unclear, although sinus thrombosis is known to be a predisposing factor for dural arteriovenous fistula. Because spontaneous CCFs are mainly of the dural type, we considered that thrombogenic conditions, such as, protein S deficiency might be associated with CCF. CASE REPORT A 42-year-old woman complained of conjunctival injection and retro-orbital pain that first appeared 1-month before visiting our hospital. She had no history of head trauma or intracranial surgery. Exophthalmos and chemosis were observed in her left eye, which also had lower visual acuity and higher intraocular pressure than the right eye. Magnetic resonance images and cerebral angiography revealed a left dural CCF. Her protein S was low, at 41% (normal range 70-140%), but other hematologic values related to coagulation were normal. Her symptoms were relieved after initial transvenous coil embolization. However, a newly developed sixth-nerve palsy was detected 4 days after initial embolization. Follow-up angiography revealed a minimal shunt, and thus transvenous coil embolization was repeated. Two days later, the ophthalmoplegia started reducing, and 1-month later it had almost disappeared.

CONCLUSIONS:

To the best of our knowledge, this is the first report of spontaneous dural CCF in a Korean patient with concurrent protein S deficiency. Interestingly, transient sixth-nerve palsy developed after transvenous coil embolization in this patient. This additional symptom caused by the residual fistula was relieved after additional transarterial embolization.
Asunto(s)

Texto completo: Disponible Índice: WPRIM (Pacífico Occidental) Asunto principal: Parálisis / Trombosis de los Senos Intracraneales / Angiografía Cerebral / Angiografía / Espectroscopía de Resonancia Magnética / Arterias Carótidas / Agudeza Visual / Seno Cavernoso / Oftalmoplejía / Exoftalmia Tipo de estudio: Estudio observacional / Estudio pronóstico Límite: Adulto / Femenino / Humanos Idioma: Inglés Revista: Journal of Clinical Neurology Año: 2011 Tipo del documento: Artículo

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Texto completo: Disponible Índice: WPRIM (Pacífico Occidental) Asunto principal: Parálisis / Trombosis de los Senos Intracraneales / Angiografía Cerebral / Angiografía / Espectroscopía de Resonancia Magnética / Arterias Carótidas / Agudeza Visual / Seno Cavernoso / Oftalmoplejía / Exoftalmia Tipo de estudio: Estudio observacional / Estudio pronóstico Límite: Adulto / Femenino / Humanos Idioma: Inglés Revista: Journal of Clinical Neurology Año: 2011 Tipo del documento: Artículo