Carotid-cavernous fistula: Difference between revisions
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**Risk factors include [[connective tissue disease]] e.g. Ehler's Danlos | **Risk factors include [[connective tissue disease]] e.g. Ehler's Danlos | ||
=Clinical Features== | ==Clinical Features== | ||
*Onset typically abrupt within hours to few days after initial insult, but may present weeks after trauma | *Onset typically abrupt within hours to few days after initial insult, but may present weeks after trauma | ||
*Symptoms due to arterialization of orbital veins | *Symptoms due to arterialization of orbital veins | ||
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==Evaluation== | ==Evaluation== | ||
*Conventional angio is gold standard, but can be seen on CT/CTA or MRI/MRA of head/orbits | *Conventional angio is gold standard, but can be seen on [[head CT|CT]]/CTA or [[brain MRI|MRI]]/MRA of head/orbits | ||
==Management== | ==Management== | ||
Latest revision as of 00:18, 2 October 2019
Background
- Fistula between carotid and cavernous sinus
- Majority arise from trauma
- Exact mechanism unclear/variable, may arise from small tear in internal carotid or branches due to basilar skull fracture (esp. through sphenoid), shear forces, or abrupt increases in intraluminal pressure when compressed due to neck flexion[1]
- May also occur spontaneously, due to aneurysms, thrombosis, or weakening in arterial wall
- Risk factors include connective tissue disease e.g. Ehler's Danlos
Clinical Features
- Onset typically abrupt within hours to few days after initial insult, but may present weeks after trauma
- Symptoms due to arterialization of orbital veins
- Pulsating exophthalmos/proptosis
- Raised intraocular pressure
- Eye pain (ocular and/or orbital), headache
- Chemosis
- Diplopia or blurry vision
- CN VI palsy
- Esotropia (eye moves inwards), diplopia
- CNIII palsy
- Exotropia (eye moves laterally)
- Ptosis
- Pupillary dilation
- Bruit (over eye or head)
Possible complications include:
- Acute angle glaucoma, vitreous hemorrhage, retinal detachment
- Can lead to vision loss
- ICH, SAH (if fistula drains into cortical veins)
- Severe epistaxis
Differential Diagnosis
Bilateral red eyes
- Painful
- Painless
Evaluation
Management
- 5-10% close spontaneously[2] remainder must be closed by interventional radiology (e.g. embolization) or surgically