ABSTRACT
Introduction: Carotid cavernous fistulas are uncommon vascular abnormalities marked by anomalous connections between the carotid artery and the cavernous sinus. The authors present a case of a direct carotid cavernous fistula and its successful treatment in a 42-year-old female. Case presentation: A 42-year-old female presented with right eye painful swelling and visual disturbance. She had no known comorbidities or history of injury. Examination showed proptosis, chemosis, and orbital bruit. Carotid angiography confirmed a carotid cavernous fistula, which was managed endovascularly. The patient fully recovered after treatment. Discussion: Carotid cavernous fistula occurs spontaneously or as a result of trauma or other vascular abnormalities. Common clinical manifestations include proptosis, chemosis, and orbital bruit, with vision loss being a feared complication. Diagnosis is typically confirmed through angiography, with digital subtraction angiography being the gold standard. Endovascular treatment is usually effective, although surgical management may be necessary in certain cases. Conclusion: Carotid cavernous fistula is a rare but potentially sight-threatening neurological condition. Treatment with a transvenous approach is effective for the management of direct carotid cavernous fistula.
ABSTRACT
Middle meningeal artery embolization is a valuable alternative for chronic subdural hematoma refractory to Burr hole surgery. In a 61-year-old patient, this endovascular intervention effectively resolved the hematoma alleviating associated symptoms.
ABSTRACT
Introduction and importance: Endovascular coiling can be used to treat residual intracranial aneurysms with prior neurosurgical clipping in aneurysmal subarachnoid haemorrhage. Aneurysmal subarachnoid haemorrhage is a rare subtype of stroke which can be life-threatening. Case presentation: The authors herein report a case of successful management by endovascular coiling of residual intracranial aneurysm post-surgical clipping in a 60-year-old male who was previously diagnosed as diffuse subarachnoid haemorrhage (SAH) Fisher grade 4. On examination, he had a Glasgow Coma Scale 14/15 with verbal confusion present and was hypertensive. Clinical discussion: Aneurysmal subarachnoid haemorrhage is a rare and serious type of stroke and may result in dependency. Endovascular coiling can be used to treat residual intracranial aneurysms with prior neurosurgical clipping. It further helps in decreasing dependency and mortality. Conclusion: Endovascular coiling is a good treatment option for patients who have undergone neurosurgical clipping as their prior surgical attempt in aneurysmal subarachnoid haemorrhage. An endovascular approach may further lead to a better prognosis.
ABSTRACT
PURPOSE: To determine the capacity of intravoxel incoherent motion (IVIM) magnetic resonance imaging (MRI) in differential diagnosis between recurrent carcinoma and postchemoradiation fibrosis of skull base in patients with nasopharyngeal carcinoma (NPC). MATERIALS AND METHODS: Eleven patients with recurrent NPC and 21 patients with postchemoradiation fibrosis in the skull base were enrolled. All the diagnoses were proved by endoscopic biopsy or imaging follow-up. IVIM MRI was performed to obtain quantitative parameters including D (pure diffusion), f (perfusion fraction), and D* (pseudodiffusion). D, f, and D* were compared between two groups; the diagnostic performances of D and f were evaluated using the receiver operating characteristic (ROC) analysis. RESULTS: D and f values were significantly lower in recurrent carcinoma than that in fibrosis (P < 0.001; P = 0.001). No significant difference was found in D* values between recurrent carcinoma and fibrosis (P = 0.229). ROC curve analysis showed that the area under the curve of D and f values were 0.996 and 0.838, respectively. Respective cutoff values with sensitivity, specificity, and accuracy were: D = 1.161 × 10-3 mm2 /s (sensitivity 100.0%, specificity 95.2%, accuracy 96.9%), f = 0.109 (sensitivity 81.8%, specificity 71.4%, accuracy 75.0%). CONCLUSION: Recurrent NPC and postchemoradiation fibrosis in the skull base have distinctive D and f values. IVIM MRI could be used to differentiate between recurrent carcinoma and postchemoradiation fibrosis in patients with NPC. J. Magn. Reson. Imaging 2016;44:1556-1564.
