An Eye with a Heartbeat: Carotid Cavernous Fistula–a Case Report

McManus, Nicholas M.; Offman, Ryan; Provatas, Tammy L.; Sievertsen, Erik E.

doi:10.1016/j.jemermed.2018.05.015

Cited by 3 publications

(2 citation statements)

References 4 publications

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“…A high index of suspicion in patients with atypical red eyes is essential for diagnosing carotid-cavernous fistulas. The classical triad of pulsating exophthalmos, ocular bruit, and conjunctival chemosis may not always present together, making the diagnosis even more challenging ( 4 ).…”

Section: Discussionmentioning

confidence: 99%

Traumatic carotid cavernous fistulas. Rare and life threatening

Petridis,

Foinitsis,

Karataglis

et al. 2023

Trauma Case Reports

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Section: Discussionmentioning

confidence: 99%

Traumatic carotid cavernous fistulas. Rare and life threatening

Petridis,

Foinitsis,

Karataglis

et al. 2023

Trauma Case Reports

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“…Most CCFs drain into the ophthalmic veins (typical venous drainage pattern), leading to the pathogenic ocular clinical triad associated with a CCF. Presenting symptoms of CCFs may include a subjective bruit, diplopia, tearing, red eye, ocular foreign body sensation, blurred vision and sometimes headache (8)(9)(10). Neurogenic strabismus most commonly presents as a sixth nerve palsy.…”

Section: Discussionmentioning

confidence: 99%

Serous retinal detachment secondary to an unsuccessful transarterial embolization in a post-traumatic carotid-cavernous sinus fistula patient: A case report

Lee

2022

Front. Med.

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A carotid-cavernous sinus fistula (CCF) is an abnormal communication between the cavernous sinus and the carotid arterial system. Direct CCFs arise from a direct connection between the cavernous sinus and the cavernous portion of the internal carotid artery. Nowadays, endovascular neurosurgery has become the first-line treatment modality for direct CCFs owing to the high complete obliteration rate. However, reversal of the clinical symptoms may not always be congruous after the endovascular intervention. Herein, we present a 50-year-old patient who manifested diplopia, ophthalmoplegia, and orbital congestion after a traffic accident. He had suffered head injury with right side frontal intracranial hemorrhage 1 month before the ophthalmic presentation. He came to our department primarily because of declining vision and for the above symptoms, and was diagnosed with direct type CCF, for which he received transarterial coil embolization. Unexpectedly, he later presented with serous retinal detachment accompanied by ocular ischemic syndrome secondary to recurrent CCF 1 month after the intervention, so repeat coil embolization was performed.

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Neuro-Ophthalmic Manifestations of Carotid Cavernous Fistulas: A Systematic Review and Meta-Analysis

Al-shalchy,

Al-Wassiti,

Hashim

et al. 2024

Cureus

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Carotid-cavernous fistulas (CCFs) are pathologic, arteriovenous communications between the carotid artery and cavernous sinus. They cause various complex neuro-ophthalmic symptoms by shunting the flow of arterial blood into the venous system. In this study, a systematic review is conducted on the neuroophthalmic presentations associated with CCFs. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines were followed during the systematic review. We searched PubMed, Scopus, and Web of Science from inception to December 31, 2023. Articles written in English on patients with confirmed CCFs reporting clinical features, diagnostic modalities, treatment approaches, and outcomes were included. Abstracted data included demography, clinical presentations, venous flow dynamics, trauma history, investigative methodology, approaches to treatment, and outcomes. Overall, 33 studies with a total number of 403 patients were included. The mean age at presentation was 42.99 years for patients with direct CCFs and 55.88 years for those with indirect CCFs. Preponderance was observed in male patients with direct CCFs, constituting 51.56%, while females predominated in those with indirect CCFs, at 56.44%. The clinical symptoms in all patients with CCFs were proptosis in 58 cases (14.39%), conjunctival congestion in 29 patients (7.20%), diplopia in nine patients (2.23%), vision blurring in four patients (0.99%), eyelid swelling in five patients (1.24%), pain in the eye in three patients (0.74%), and an upper lid mass in one patient (0.25%). Endovascular treatments, including coil and Onyx embolization, have been effective in relieving clinical symptoms and arresting the progression of these symptoms. In conclusion, the common clinical features in CCFs usually underline proptosis, congestion, and diplopia, necessitating a comprehensive neuro-ophthalmological review. Prompt identification of the symptoms of blurred vision is crucial to avoid permanent damage. Lid swelling, ocular pain, and an upper lid mass are less common but equally essential presentations for comprehensive evaluation. The recognition of these variable presentations is essential not only for timely intervention but also for the improvement in patient outcomes, thus emphasizing the role of clinician awareness in managing CCF cases.

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An Eye with a Heartbeat: Carotid Cavernous Fistula–a Case Report

Cited by 3 publications

References 4 publications

Traumatic carotid cavernous fistulas. Rare and life threatening

Traumatic carotid cavernous fistulas. Rare and life threatening

Serous retinal detachment secondary to an unsuccessful transarterial embolization in a post-traumatic carotid-cavernous sinus fistula patient: A case report

Neuro-Ophthalmic Manifestations of Carotid Cavernous Fistulas: A Systematic Review and Meta-Analysis

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