The hockey-stick sign in a patient with unilateral proptosis

Abstract

Correspondence to Rakesh Biswas, rakesh7biswas@gmail.com DESCRIPTIONA 23-year-old man presented with left-sided headache, protrusion of eye ball and hearing of some abnormal gurgling sound within the head for a period of 1 month. There was no history of trauma, collagen disorder or hypertension.On examination, the right eye was normal. In the left eye, however, there was axial proptosis with dilated and tortuous conjunctival blood vessels (figure 1). Pulsations could be felt over the eye ball and a bruit was also audible. Patient was put on a combination of timolol 0.5% and bimatoprost 0.03% eye drops once a day to control the IOP. Then he underwent transvenous embolisation of CCF with detachable balloons to close the fistula. Three months after embolisation, the patient presented with normal IOP and resolution of all signs and symptoms. DISCUSSIONA high index of suspicion is the key factor in diagnosing a case of CCF without any history of trauma and collagen vascular disease. Approximately 25% of the CCF is of the spontaneous variety. 1In CCF the arterial pressure is directly transmitted to the orbital veins; therefore, there is venous congestion and decreased arterial perfusion to the globe. Both these events lead to the classical signs and symptoms of severe ipsilateral headache, homolateral carotid bruit, pulsating exophthalmos, dilated episcleral veins and increased IOP due to raised episcleral venous pressure.2 CT and MRI are useful screening tools, which may show dilatation of the superior ophthalmic vein (80%), increased extra ocular muscle size(65%), or enlargement of cavernous sinus(35%). 3Acknowledgement To all those who cared for this patient.