Involvement of methicillin-susceptible Staphylococcus aureus related to sequence type 25 and harboring pvl genes in a case of carotid cavernous fistula after community-associated sepsis.

Staphylococcus aureus encoding Panton-Valentine leukocidin (PVL) genes has become the cause of life-threatening infections. We describe a case of carotid cavernous fistula after bacteremia in a 12-year-old male, caused by a methicillin-susceptible S. aureus isolate carrying the pvl, fnbA, and ebpS genes and related to sequence type 25 (ST25). The patient's condition was complicated by pleural empyema and osteomyelitis in the right femur. The patient was discharged in good clinical condition after 160 days of hospitalization.

Fístula carotidea cavernosa asociada a síndrome de secreción inadecuada de hormona antidiurética / Carotid cavernous fistula associated with syndrome of inappropriate secretion of antidiuretic hormone

La fístula carótido-cavernosa (FCC) es una comunicación anómala que se establece entre la arteria carótida y el seno cavernoso y se produce un shunt arteriovenoso patológico. Actualmente la mayoría de estas lesiones son tratadas por técnicas endovasculares(1,2). La hiponatremia es el trastorno hidroelectrolítico más frecuente y aproximadamente un tercio de las mismas se deben al síndrome de secreción inadecuada de hormona antidiuretica (SIADH). El SIADH se ha relacionado con alteraciones del SNC, entre los que destacan los traumatismos craneoencefálicos(3). Presentamos el caso de una paciente de 43 años que consulta por presentar cuadro de agitación psicomotriz e insomnio asociado a cuadro de síncope y en los días posteriores presenta cefalea y disminución progresiva de la agudeza visual. Como antecedente de importancia tuvo traumatismo craneoencefálico un mes antes de su consulta. Al examen físico se observa edema periorbitario de ojo derecho condilatación de los vasos de la conjuntiva, proptosis; a la auscultación del globo ocular se apreciaba un soplo y en el fondo del ojo se observa la presencia de edema de papila. En los exámenes de laboratorio Sodio: 118 meq/L; Osmolaridad Plasmática: 267 m0sm; Osmolaridad Urinaria: 1100 mosm; Sodio Urinario: 35 meq/L...

The carotid cavernous fistula is an abnormal connectivity between the carotid artery and the cavernous sinus and produces a pathologic shunt between an artery and a vein. These lesions are usually treated with endovascular techniques. Hyponatremia is the most frequent electrolitic disorder found, and approximately one third is due to a syndrome of inappropriate secretion of antidiuretic hormone (ISADH). It has been related to SNC alterations; one of the causes can be craneoencephalic trauma. We present a 43 year old patient who consulted with agitation and insomnia, later on she had an episode of syncope and in the following days headache and impaired vision. This patient had suffered a cranial trauma a month before consultation. At the physical examination a right periorbitary edema, proptosis and vessels dilatation were seen; a murmur could be heard on that eye and the fundus exploration showed papilledema. Laboratory showed: sodium: 118 meq/L; plasmatic osmolarity: 267 mOsm; urinary Osmolarity: 1100 mOms; urinary sodium: 35 meq/L...

Peoría paradójica en fístulas carótido-cavernosas durales: cuando el cuerpo se enferma más para curarse / Paradoxical worsening in carotid-cavemous ductal fistulas: when the body get more sick in order to cure

Las fístulas carótido-cavernosas son comunicaciones arteriovenosas patológicas entre la arteria carótida interna intravenosa y el seno venoso-cavernoso que la rodea. Un sistema de flujo y presión elevados irrumpe sobre otro de bajo flujo y velocidad. Ello origina los síntomas y signos. La gran mayoría, son resultantes de traumatismos craneales siendo de alto flujo y alta velocidad-fístulas traumáticas o directas; menos comunes son las llamadas fístulas espontáneas o durales localizadas en la duramadre y alimentadas por ramas menígeas provenientes de las arterías carótidas externa, interna o ambas y de las arterias vertebrales. Estas últimas raras veces tienen implicaciones graves para la vida, pero la pérdida visual constituye el mayor riesgo; no obstante, con elevada frecuencia, ocurre la oclusión espontánea, por lo que se impone la observación hasta que la sintomatología justifique el tratamiento. En el curso evolutivo puede ocurrir la trombosis aguda de la fístula y más propiamente de la totalidad de la vena oftálmica superior la que produce un distintivo cuadro de notable agravamiento de los síntomas que en forma contradictoria ocurre antes de la mejoría y reversión de los síntomas, el síndrome de empeoramiento o peoría paradójica. Para ilustrar el síndrome se presentan los casos clínicos de los pacientes

Caroid-cavernous fistulas are pathological arteriovenous communications between the intracavernous internal carotid artery and the cavernous sinus. A system of high flow and pressure bursts over another system of low flow and slow velocity. This causes the symptoms and signs. The vast majority are related with head trauma being high flow and high speed fistulas: traumatic or direct. Less common are the so-called spontaneous or dural fistulas located in the duramater and fed by meningeal branches from the external, internal, or both carotic arteries and the vertebral arteries. These latest rarely have serious implications for life, but visual loss is the greatest risk; however, with high frequency spontaneously occlusion occurs, and then observation imposes until symptoms justified the treatment. During its evolution acute thrombosis of the fistula itself can occur along the entire length of the ophthalmic vein which produces a distinctive and paradoxical worserning and reversal of symptoms, which is called the syndrome of paradoxical worserning. Clinical cases of two patients are presented to illustrate the syndrome

Management of direct carotid-cavernous sinus fistulas with the use of ethylene-vinyl alcohol (Onyx) only: preliminary results.

OBJECT: So-called direct carotid-cavernous fistulas (CCFs) are commonly treated by detachable balloons or coils to occlude the shunt while sparing the carotid artery. Liquid embolic agents have been rarely used, and in particular, to the authors' knowledge, the use of Onyx as the sole agent has never been reported in an indexed publication. METHODS: The authors describe a case series of 5 patients with posttraumatic CCF in whom embolization with Onyx was prospectively used as the sole strategy of management. RESULTS: Complete occlusion was obtained at the end of the procedure in 4 cases, and the lesion in the remaining patient subsequently occluded at the 6-month follow-up evaluation. CONCLUSIONS: As endovascular techniques for treatment of direct CCFs continue to evolve, this novel approach with Onyx as the sole embolic material seems promising in treating these lesions.

Endovascular treatment of carotid-cavernous fistulas: review of 12 cases.

Carotid-cavernous fistulas (CCFs) are an uncommon pathology in current neurosurgical practice. Furthermore, they generally present a challenge to the neurosurgeon because of both their deep location and the major neurovascular structures that surround them. CCFs consist of a vascular anomaly in which blood flows from meningeal branches of the internal and external carotid arteries, or directly from the internal carotid artery, into the venous circulation around and in the cavernous sinus. Twelve patients with direct and indirect/dural CCFs who underwent examination and treatment between July 2003 and February 2006 are reported here. All patients of this retrospective evaluation were symptomatic at the time of diagnosis, which was confirmed by cerebral angiography. The patients were treated by endovascular approaches and the CCFs were occluded. From our evaluation, we concluded that the endovascular procedure is safe, effective and minimally invasive in patients with CCF.