Carotid - cavernous fistula

Abstract

The clinical features of cerebral aneurysm have become more clearly defined in recent years, due largely to advances made possible by arterio graphy and neurosurgery. Among the aneurysm syndromes which have benefited by the newer methods of diagnosis and treatment, is that of communicating aneurysm of the internal carotid artery and the cavernous sinus. Though the clinical features of aneurysm involving these structures is well-known, it is desirable to review them in the light of newer knowledge, in order to define their diagnosis and to suggest treatment. REPORT OF CASES Case 1-W. 8. (Jeff. Hosp. No. JH 13595)-A 57 year old white gardener with sudden loss of consciousness about a year before admission to the hospital. Eleven months later sudden almost complete closure of left eye. A feiv days throbbing headache in the left frontal region associated with a "hammering noise" in his head. A week later right eye involved. Examination revealed, bilateral ptosis, more marked on the left, complete ophthalmoplegia on the left and almost complete on the right except for slight lateral motion. Corneal reflex absent on the left and diminished on the right. Definite impairment of sensation in the distribution of the left ophthalmic nerve. Distinct bruit over both eyes, in both temples and over both mastoids. A diagnosis of arteriovenous aneurysm in the cavernous sinus was made and the left common carotid artery ligated. The patient improved markedly. Later arteriography confirmed the diagnosis of left internal carotidcavernous sinus fistula.

Trombose traumática da artéria carótida associada a fístula carótido-cavernosa ipsolateral tardia

“…As obstruções tem como causa principal os traumatismos de crânio sem penetração de corpo estranho, devido ao traumatismo da artéria nas eminências ósseas do atlas e axis 1 . 7 > 11 ; entretanto, ocorrem também em traumatismos de pescoço, sobretudo em pessoas idosas, devido ao deslocamento de placas ateromatosas 1 . Por outro lado, as mudanças de direção de fluxo ocorrem em traumatismos de pescoço com penetração de corpo estranho, extravazando o sangue 4 , ou então nos traumatismos de crânio com ou sem penetração de corpo estranho, mas que provoquem fratura de base levando à fístula carótido-cavernosa.…”