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1.
BMJ Case Rep ; 16(4)2023 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-37076195

RESUMO

Carotid cavernous fistulas (CCFs) can present with varied ophthalmic manifestations. The most important vision-threatening complications of CCF include glaucoma and retinal vascular occlusions. We report a case of a man in his early 30s who developed a post-traumatic direct CCF. The patient denied undergoing embolisation therapy. This resulted in aggravation of his condition with onset of combined retinal venous and artery occlusion leading to neovascular glaucoma and severe vision loss. He was treated with medical management followed by diode laser photocoagulation to control intraocular pressure. Diagnostic cerebral angiography done 3 months later showed complete closure of the fistula; hence, no further intervention was advocated. Combined vascular occlusion is a rare vision-threatening occurrence in cases of CCF. Timely intervention with closure of the fistula can prevent the development of vision-threatening complications.


Assuntos
Fístula Carotidocavernosa , Embolização Terapêutica , Fístula , Glaucoma Neovascular , Doenças Retinianas , Masculino , Humanos , Fístula Carotidocavernosa/complicações , Fístula Carotidocavernosa/diagnóstico por imagem , Fístula Carotidocavernosa/terapia , Glaucoma Neovascular/diagnóstico , Glaucoma Neovascular/etiologia , Glaucoma Neovascular/terapia , Fístula/complicações , Transtornos da Visão/etiologia , Doenças Retinianas/complicações , Embolização Terapêutica/efeitos adversos
2.
Rom J Ophthalmol ; 66(2): 168-172, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35935074

RESUMO

Purpose: To report a case of indirect carotid-cavernous fistula (CCF) in a patient who presented as a case of thyroid-associated orbitopathy (TAO). Case presentation: A 60-year-old female, known case of hypothyroidism, presented with left-sided headache associated with pain, protrusion and redness of left eye, the examination revealing vision of 20/ 80, proptosis, chemosis and severe ophthalmoplegia. All routine investigations were normal, including thyroid hormone levels. MRI brain & orbits showed increase in bulk of all extraocular muscles with tendon sparing. In view of suspicion of TAO, she was initially misdiagnosed and treated with parenteral and oral steroids, which resulted in further worsening of vision. Optical coherence tomography macula of the left eye revealed acute central serous chorioretinopathy that compelled the stoppage of steroids. While reviewing the patient again, dilated cork-screw tortuous episcleral vessels were found in the left eye. Thus, advised Digital subtraction angiography, confirmed as a case of low-flow left Indirect CCF, managed with endovascular embolization therapy improved her ocular symptoms completely in three days. Conclusion: CCF may mimic TAO due to overlapping features. In-view of different treatment protocols for both, it is critically important to look for atypical features in thyroid eye disease and keep CCF as one of the differential diagnoses for accurate management. Abbreviations: CCF = carotid-cavernous fistula, ICA = internal carotid artery, ECA = external carotid artery, TAO = thyroid-associated ophthalmopathy, BCVA = best corrected visual acuity, MRI = magnetic resonance imaging, IVMP = intravenous methylprednisolone, OCT = Optical coherence tomography, CSCR = central serous chorioretinopathy, DSA = digital subtraction angiography, IOP = intraocular pressure, CT = computed tomography.


Assuntos
Fístula Carotidocavernosa , Coriorretinopatia Serosa Central , Embolização Terapêutica , Exoftalmia , Fístula , Oftalmopatia de Graves , Fístula Carotidocavernosa/cirurgia , Fístula Carotidocavernosa/terapia , Embolização Terapêutica/métodos , Exoftalmia/diagnóstico , Exoftalmia/etiologia , Feminino , Fístula/complicações , Fístula/terapia , Oftalmopatia de Graves/complicações , Oftalmopatia de Graves/diagnóstico , Oftalmopatia de Graves/terapia , Humanos , Pessoa de Meia-Idade
3.
R I Med J (2013) ; 104(9): 70-72, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34705914

RESUMO

Indirect carotid cavernous fistulas (CCFs) are most often spontaneous, but can rarely be caused by trauma. With traumatic etiology, the timeline for the development of symptoms varies significantly and can be difficult to predict. In this report, we discuss the case of a patient found to have an indirect CCF who presented for acutely worsening ocular symptoms and a history of pulsatile tinnitus that began two years prior after a suspected inciting head injury. To our knowledge, no cases have described a traumatic indirect CCF with a similarly extensive indolent course who demonstrated full symptomatic recovery following treatment.


Assuntos
Fístula Carotidocavernosa , Traumatismos Craniocerebrais , Fístula , Zumbido , Fístula Carotidocavernosa/diagnóstico por imagem , Fístula Carotidocavernosa/etiologia , Fístula Carotidocavernosa/terapia , Traumatismos Craniocerebrais/complicações , Humanos , Zumbido/etiologia
4.
BMJ Case Rep ; 20152015 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-25612750

RESUMO

Inadequate information is available about the cerebral blood flow and surgical strategies of a direct aneurysmal carotid cavernous fistula (daCCF). We report a quantitative analysis of flow velocity and volume using preoperative time-resolved phase-contrast MRI (four-dimensional (4D) flow MRI) in a daCCF. This is the first report of 4D flow findings with a daCCF. A 55-year-old woman developed a sudden headache and bruit of the right orbit, and MRI suggested the presence of a daCCF. Quantitative analysis using preoperative 4D flow MRI revealed the flow volume of the right internal carotid artery. The daCCF was successfully treated by high-flow bypass using a radial artery graft and internal carotid artery trapping. Postoperative angiography showed a complete obliteration of the daCCF. Studies to collect data from additional cases are required so that 4D flow findings can be further used in the management of daCCFs.


Assuntos
Aneurisma Roto/complicações , Encéfalo/irrigação sanguínea , Artéria Carótida Interna/patologia , Fístula Carotidocavernosa/diagnóstico , Circulação Cerebrovascular , Aneurisma Intracraniano/complicações , Angiografia por Ressonância Magnética/métodos , Fístula Carotidocavernosa/etiologia , Fístula Carotidocavernosa/fisiopatologia , Fístula Carotidocavernosa/terapia , Seio Cavernoso/patologia , Angiografia Cerebral , Embolização Terapêutica , Feminino , Fístula , Humanos , Pessoa de Meia-Idade , Artéria Radial , Enxerto Vascular
5.
J Head Trauma Rehabil ; 29(5): 432-42, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-23982788

RESUMO

BACKGROUND: Up to 53% of individuals suffering from traumatic brain injuries develop tinnitus. OBJECTIVE: To review the current literature on trauma-associated tinnitus in order to provide orientation for the clinical management of patients with trauma-associated tinnitus. MATERIALS: A systematic literature search has been conducted in PubMed database applying the search terms posttraumatic tinnitus and trauma-associated tinnitus. Results have been complemented by related studies, book chapters, and the authors' clinical experience. RESULTS: Not only mechanical, pressure-related, or noise-related head traumata but also neck injuries and emotional trauma can cause tinnitus. Exact diagnosis is essential. Disorders such as ossicular chain disruption, traumatic eardrum perforation, or perilymphatic fistula can be surgically treated. It should also be considered that pulsatile tinnitus can be a sign of life-threatening disorders such as carotid cavernous fistulas, arteriovenous malformations, and carotid dissections. Also, posttraumatic stress disorder should be taken into consideration as a potential contributing factor. CONCLUSIONS: There is an evident mismatch between the high incidence of trauma-associated tinnitus and scarce literature on the topic. A consistent and-at best-standardized assessment of tinnitus- and hearing-related sequelae of trauma is recommended both for the improvement of clinical care and for a deeper understanding of the various pathophysiological mechanisms of trauma-associated tinnitus.


Assuntos
Zumbido/etiologia , Barotrauma/complicações , Traumatismos por Explosões/complicações , Lesões Encefálicas/complicações , Lesões das Artérias Carótidas/complicações , Fístula Carotidocavernosa/complicações , Ossículos da Orelha/lesões , Orelha Interna/lesões , Fístula/complicações , Humanos , Doenças do Labirinto/complicações , Lesões do Pescoço/complicações , Ruído/efeitos adversos , Fraturas Cranianas/complicações , Transtornos de Estresse Pós-Traumáticos/complicações , Osso Temporal/lesões
6.
Arch. Soc. Esp. Oftalmol ; 83(12): 719-722, dic. 2008. ilus
Artigo em Es | IBECS | ID: ibc-70395

RESUMO

Caso clínico: Varón con fístula carótido-cavernosa (FCC) izquierda y antecedentes previos de embolización no exitosos del seno petroso inferior izquierdo con cateterismo venoso femoral. Se realizó embolización de la fístula canalizando directamente la vena oftálmica superior (VOS). Discusión: La principal modalidad de tratamiento para las FCC es la radiología intervencionista que pretende la oclusión de la fístula vía arterial a través del seno cavernoso; o por vía venosa, a través del seno petroso inferior. Sin embargo, también puede accederse a la FCC a través de la VOS


Case report: A male patient with a left carotid-cavernous sinus fistula (CCSF) and two previous attempts of embolization via the femoral vein was treated with embolization through the superior ophthalmic vein (SOV). Discussion: The main modality of treatment for CCSF is intervention radiology. This aims to occlude the fistula via an arterial route, through the cavernous sinus, or via a venous route, through the inferior petrosus sinus. However, the CCSF is also accessible through the SOV (Arch Soc Esp Oftalmol 2008; 83: 719-722)


Assuntos
Humanos , Masculino , Idoso , Fístula/complicações , Fístula/diagnóstico , Fístula/terapia , Embolização Terapêutica/métodos , Equimose/complicações , Equimose/diagnóstico , Oftalmoscopia/métodos , Gonioscopia/métodos , Embolização Terapêutica/instrumentação , Embolização Terapêutica/tendências , Embolização Terapêutica , Angiografia/métodos
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