A tricky case of unilateral orbital inflammation: carotid cavernous  fistula in Graves-Basedow disease

Lacorzana, Javier; Rocha‐de‐Lossada, Carlos; Ortiz-Pérez, Santiago

doi:10.22336/rjo.2021.40

Cited by 3 publications

(2 citation statements)

References 5 publications

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“…GD is an autoimmune disorder that is more frequent between 20 and 50 years of age and occurs in 2% of women. 4 , 5 The annual incidence of GO is 16 per 100,000 women. 2 The symptoms of GO include a dry, gritty feeling in the eyes, photophobia, excessive tearing, double vision, and pressure feeling behind the eyes, as reported by nearly half of the patients of Graves’ hyperthyroidism.…”

Section: Discussionmentioning

confidence: 99%

“… 1 Unlike bilateral proptosis, which is mostly seen in thyroid disease, unilateral proptosis has a great variety of differential diagnoses, including orbital pseudotumor, orbital cellulitis, cavernous sinus thrombosis, or intra-orbital neoplasms. 4 Unilateral ophthalmopathy mostly progresses to bilateral disease, while only 5–11% of cases show no progression, making pure unilateral ophthalmopathy rare. 1 Here, we present the case of a young female with GD who developed unilateral proptosis without any visual disturbances.…”

Section: Introductionmentioning

confidence: 99%

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Unilateral proptosis in a patient with thyroid eye disease: A case report

Bhattarai¹,

Thapaliya

Dhungana

et al. 2023

SAGE Open Medical Case Reports

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Unilateral proptosis is an abnormality in which one eye sticks out forward more than the other. Bulging of the eye is commonly seen in Graves’ ophthalmopathy, but it’s mostly bilateral. Thyroid eye disease presents as the most common extrathyroidal manifestation of Graves’ disease, and rarely leads to unilateral proptosis. A 25-year-old female with a history of weight loss, menstrual irregularities, and palpitations presented with progressive right eye bulging, which was further confirmed by magnetic resonance imaging and biochemical investigations. Magnetic resonance imaging of the orbit revealed unilateral extraocular muscle enlargement and enhancement with sparing of the tendons. Timely therapy is crucial for reversing the ocular manifestations of thyroid eye disease.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Unilateral proptosis in a patient with thyroid eye disease: A case report

Bhattarai¹,

Thapaliya

Dhungana

et al. 2023

SAGE Open Medical Case Reports

View full text Add to dashboard Cite

show abstract

Orbital Vascular Anomalies and Vascular Tumours

Ortiz-Pérez,

Quaranta Leoni,

Verity

2024

Oculoplastic, Lacrimal and Orbital Surgery

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Complexity in the diagnosis of endocrine ophthalmopathy with a carotid-cavernous fistula. A clinical case

Tsyplina,

Pochechueva,

Yanchenko

et al. 2024

jour

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Introduction. Clinical cases featuring a combination of endocrine ophthalmopathy with a carotid-cavernous fistula are scarce, with only four cases documented in the literature, thus posing a diagnostic challenge due to overlapping clinical symptoms. A carotid-cavernous fistula with high blood flow typically presents a clear clinical picture. However, low-flow variants are challenging to timely diagnose. A history of head trauma can be an essential diagnostic clue, as carotid-cavernous anastomosis develops in 75% of cases post-trauma and in 25% spontaneously. Bilateral carotid-cavernous fistulas are particularly rare.Purpose: to present the clinical features and outcomes of bilateral endocrine ophthalmopathy associated with a non-traumatic carotid-cavernous fistula, based on the prospective observation of a patient treated in various city healthcare hospitals during 2021–2022.Case description. The patient first visited the ophthalmologist in October 2021, presenting with bilateral exophthalmos, edema, and eye redness. A positive test for antibodies to thyroid-stimulating hormone and enlargement of the eye muscles, confirmed by orbital ultrasound, led to a diagnosis of “Endocrine Ophthalmopathy”. The patient’s condition was managed jointly by an endocrinologist and an ophthalmologist. Over two months, a worsening of ocular symptoms was observed, prompting a neurosurgical consultation. Cerebral angiography conducted in a hospital setting confirmed a carotid-cavernous fistula. An endovascular procedure was performed five months after the initial ocular symptoms appeared to separate the carotid-cavernous anastomosis on the right using a non-adhesive composition. Ocular symptoms resolved within 2–3 weeks post-surgery.Conclusions. Clinical manifestations of carotid-cavernous fistulas can resemble those of endocrine ophthalmopathy. The absence of a traumatic head injury history, complaints of unilateral head noise synchronous with the pulse, and the bilateral nature of the symptoms complicated the diagnosis of this neurosurgical pathology in a patient with endocrine ophthalmopathy. It is crucial to include both conditions in the differential diagnosis and to employ a multidisciplinary approach for effective management.

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A tricky case of unilateral orbital inflammation: carotid cavernous fistula in Graves-Basedow disease

Cited by 3 publications

References 5 publications

Unilateral proptosis in a patient with thyroid eye disease: A case report

Unilateral proptosis in a patient with thyroid eye disease: A case report

Orbital Vascular Anomalies and Vascular Tumours

Complexity in the diagnosis of endocrine ophthalmopathy with a carotid-cavernous fistula. A clinical case

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