Dural arteriovenous fistula and spontaneous choroidal detachment: new cause of an old disease.

Abstract

SUMMARY A case is presented in which bilateral spontaneous choroidal detachments appear to be the direct result of bilateral dural arteriovenous fistula of the cavernous sinus region. Rapid resolution of the clinical signs followed bilateral orbital decompression via the transfrontal approach. Similarities in clinical presentation of both entities are reviewed and a premise for their cause-andeffect relationship elaborated. A literature search for similar unrecognised cases is discussed. The paper suggests that this association may be more frequent than published reports would imply.

Choroidal Detachment Associated with Direct Spontaneous Carotid-Cavernous Sinus Fistula

“…We could find only 7 similar cases in a review o f the literature [2][3][4][5]. The first case reported by Woillez et al [4] was a unilateral posttraumatic, direct, high-flow CCSF with choroidal detachment occurring in the ipsilateral eye fol lowing a third surgical procedure.…”

“…The first case reported by Woillez et al [4] was a unilateral posttraumatic, direct, high-flow CCSF with choroidal detachment occurring in the ipsilateral eye fol lowing a third surgical procedure. Harbison et al [2] de- scribed the second case who had bilateral low-flow dural CCSF with choroidal detachment. Jergensen and Guthoff [3] documented 4 cases of choroidal detachment as a clin ical manifestation of spontaneous dural CCSF among 20 patients.…”

“…Spontaneous dural fistulas have a rela tively mild clinical course compared with direct fistulas. Seventy-five percent of arteriovenous fistulas occur as the result of head trauma, the rest occur spontaneously [1,2], We hereby present a rare case with choroidal detachment complicating direct spontaneous CCSF, which recurred af ter thrombosis of the superior ophthalmic vein.…”

“…The combination of reduced ar terial perfusion and raised venous pressure creates orbital and ocular hypoxia. The resulting fistula can produce ex ophthalmos, pain, redness, diplopia and increased intraoc ular pressure [1][2][3]. Spontaneous dural fistulas have a rela tively mild clinical course compared with direct fistulas.…”

“…A carotid-cavernous sinus fistula (CCSF) is an abnormal communication between a branch of the carotid artery and a cavernous sinus [1][2][3]. Clinically and angiographically, CCSFs can be subdivided as spontaneous or traumatic, high or low flow, direct or dural.…”