A Case of Spontaneous Bilateral Direct Carotid-Cavernous Fistula

A 92-year-old female with poorly controlled systemic hypertension presented with bilateral eye redness, lid fullness, conjunctival chemosis, ophthalmoplegia, and ptosis for two days. A neuro-ophthalmic evaluation revealed bilateral proptosis, severe conjunctival chemosis and congestion, and an almos...

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Veröffentlicht in:Curēus (Palo Alto, CA) CA), 2022-04, Vol.14 (4), p.e24634
Hauptverfasser: Pellegrini, Francesco, Zappacosta, Antonio, Cirone, Daniele, Ciabattoni, Cristina, Lee, Andrew G
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Sprache:eng
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Zusammenfassung:A 92-year-old female with poorly controlled systemic hypertension presented with bilateral eye redness, lid fullness, conjunctival chemosis, ophthalmoplegia, and ptosis for two days. A neuro-ophthalmic evaluation revealed bilateral proptosis, severe conjunctival chemosis and congestion, and an almost complete bilateral ophthalmoplegia with a complete right superior eyelid ptosis. Computed tomography (CT) scans demonstrated bilateral dilation of the superior ophthalmic veins, and a CT angiography (CTA) showed a direct high-flow carotid-cavernous fistula (CCF) with secondary extraocular muscle enlargement. Clinicians should be aware that a typical direct high-flow CCF, although usually occurs after trauma and unilaterally, can present spontaneously without trauma and bilaterally.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.24634