Dural carotid cavernous fistula following hypertensive emergency

Law, Geoffrey; Docherty, Gavin

doi:10.1136/bcr-2019-230823

“…In 2019, Law and Docherty described the first case of indirect CCF after an episode of hypertensive emergency. The presentation and evolution of the case were similar to what we describe in this article [7]. Diabetes mellitus has also been described as an underlying etiology of CCFs [2].…”

Section: Discussionsupporting

confidence: 79%

“…Thus, in some of these patients with low-flow shunts, the initial medical approach is conservative, using drugs to relieve ocular symptoms and manual intermittent ipsilateral carotid compression. In cases like the one we describe in this article, in which there are secondary ocular complications from CCFs, carotid compression is not recommended, and the treatment should be endovascular or surgical [ 2 , 7 ]. Relief of eye symptoms can help, but, as happened with our patient, definitive treatment is based on reducing venous pressure [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

A Rare and Surprising Case of Spontaneous Type B Carotid-Cavernous Fistula in an Internal Medicine Ward

Campos¹,

Gonçalves²,

Cardoso³

et al. 2022

Cureus

0

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Carotid-cavernous fistulas are abnormal communications between the carotid arteries and the cavernous sinus. They can be spontaneous, which is rare, or acquired, most often post-traumatic. We describe the case of a 59-year-old woman with complaints of right-sided red eye and blurred vision that did not improve with antibiotic treatment for bacterial conjunctivitis, progressing to what appeared to be post-septal cellulitis. The patient had exuberant chemosis, diplopia, VI cranial nerve palsy, and elevated intraocular pressure in the right eye. Computed tomography of the orbits showed right-sided thickening of the soft tissues of the upper eyelid and the medial and lateral rectus muscles, and an enlargement of the ipsilateral superior ophthalmic vein. However, antibiotics did not cause any kind of improvement. After a laborious diagnostic march, the diagnosis of a rare case of Barrow type B spontaneous carotid-cavernous fistula was confirmed. The patient underwent confirmatory angiography with endovascular treatment at the same time, showing rapid improvement after the procedure, without any sequelae. It is of great importance that clinicians are alert to this diagnosis, as diagnostic and therapeutic delay can lead to severe ocular compromise. In patients with a presumptive diagnosis of conjunctivitis and/or orbital cellulitis that does not improve with antibiotic treatment, the differential diagnosis with this rare entity should be considered, so that the appropriate treatment can be timely instituted.

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“…We think that the CC in this case was caused by perfusion disorder in the SOV via the CS in ltrated by PitNET. SOV dilation is characteristically observed in CS disease, such as dural CCF [6,7]. However, SOV dilation is rarely caused by PitNET and has never been reported.…”

Section: Discussionmentioning

confidence: 99%

A case report of pituitary neuroendocrine tumor manifesting as severe conjunctival chemosis

Yamamuro

¹

,

Yoshino

²

,

Nishide

³

et al. 2023

Preprint

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Background Conjunctival chemosis (CC) is an extremely rare symptom of pituitary neuroendocrine tumor (PitNET). We report an extremely rare case of PitNET manifesting as severe CC. Case presentation A 48-year-old male was admitted to our hospital with severe CC, proptosis, and ptosis of the right eye. Magnetic resonance imaging demonstrated the tumor mass invading the cavernous sinus (CS) with cystic lesion. The patient underwent emergent endoscopic transsphenoidal surgery, and the pathological diagnosis was PitNET. CC of the right eye remarkably improved after the surgery. Glucocorticoid therapy was performed for right oculomotor nerve palsy, which rapidly improved. The postoperative course was uneventful and the patient was discharged from our hospital without hormone replacement. Conclusions CC caused by CS invasion of PitNET can be cured by early surgical treatment. Therefore, PitNET is important to consider in the differential diagnosis of CC.

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A case report of pituitary neuroendocrine tumor manifesting as severe conjunctival chemosis

Yamamuro,

Yoshino,

Nishide

et al. 2023

BMC Ophthalmol

0

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Background Conjunctival chemosis (CC) is an extremely rare symptom of pituitary neuroendocrine tumor (PitNET). We report an extremely rare case of PitNET manifesting as severe CC. Case presentation A 48-year-old male was admitted to our hospital with severe CC, proptosis, and ptosis of the right eye. Magnetic resonance imaging demonstrated the tumor mass invading the cavernous sinus (CS) with cystic lesion. The patient underwent emergent endoscopic transsphenoidal surgery, and the pathological diagnosis was PitNET. CC of the right eye remarkably improved after the surgery. Glucocorticoid therapy was performed for right oculomotor nerve palsy, which rapidly improved. The postoperative course was uneventful and the patient was discharged from our hospital without hormone replacement. Conclusions CC caused by CS invasion of PitNET can be cured by early surgical treatment. Therefore, PitNET is important to consider in the differential diagnosis of CC.

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Dural carotid cavernous fistula following hypertensive emergency

Cited by 4 publications

References 12 publications

A Rare and Surprising Case of Spontaneous Type B Carotid-Cavernous Fistula in an Internal Medicine Ward

A Rare and Surprising Case of Spontaneous Type B Carotid-Cavernous Fistula in an Internal Medicine Ward

A case report of pituitary neuroendocrine tumor manifesting as severe conjunctival chemosis

A case report of pituitary neuroendocrine tumor manifesting as severe conjunctival chemosis

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