Visual impairment in high flow and low flow carotid cavernous fistula

Abstract

Our aim is to study the varied posterior segment manifestations, level of visual impairment (VI) and its causes in carotid cavernous fistula (CCF) patients. A retrospective study was done, wherein data was obtained from 48 digital subtraction angiogram (DSA) proven CCF patients. CCF was classified according to Barrow et al ., based on DSA into type A (high flow) and types B, C and D (low flow). High flow CCF was present in 8 (16.7%) and low flow CCF was present in 42 (83.3%). Compared to low flow group, patients in high flow group were younger and had a history of trauma (p < 0.05). Posterior segment findings ranged from familiar stasis retinopathy and optic neuropathy (both, glaucomatous and ischemic) to uncommon findings of central retinal artery occlusion, Terson syndrome and combined retinal and choroidal detachment. Retinal vein dilatation was the most common finding in both groups. The high flow CCF group had 6 (75%) patients that had VI. This was acute in 4 (50%) patients and delayed in 2 (25%). In the low flow group 10 (23.8%) of patients had delayed VI. The identification of “3 point sign” is a novel finding of this study, not described before. While none of three findings (disc hyperaemia, retinal vein dilatation and intra-retinal haemorrhage) in isolation were predictive of visual loss, but when present together results in visual loss. Posterior segment changes were varied, some are uncommon and can occur in various combinations. “3 point sign” must be identified at the earliest to prevent visual impairment. The incidence of VI in CCF patients is high.

Likelihood of spontaneous closure of cavernous sinus dural arteriovenous fistulas based on clinical and radiological findings

“…The cause of visual acuity impairment in these patients with CSDAVF can be attributed to vascular congestion, likely leading to retina ischemia or venous stasis retinopathy. 6 These can be reversible if detected early and treated, as seen in our patients. Hence, early detection of deteriorating visual acuity with early intervention is important to prevent permanent and irreparable visual impairment.…”

Likelihood of spontaneous closure of cavernous sinus dural arteriovenous fistulas based on clinical and radiological findings

“…The cause of visual acuity impairment in these patients with CSDAVF can be attributed to vascular congestion, likely leading to retina ischemia or venous stasis retinopathy. 6 These can be reversible if detected early and treated, as seen in our patients. Hence, early detection of deteriorating visual acuity with early intervention is important to prevent permanent and irreparable visual impairment.…”

Microvascular and neural alterations in carotid cavernous fistulas: An optical coherence tomography angiography study

“…The low-flow CCF patients (63% in our study and 83.3% in another study 8 ) had mild signs and symptoms, which could lead to delayed diagnosis and intervention,…”

“…The low‐flow CCF patients (63% in our study and 83.3% in another study 8 ) had mild signs and symptoms, which could lead to delayed diagnosis and intervention, resulting in vision loss. Therefore, a lower threshold of suspicion and a higher index of imaging diagnosis was required.…”

Direct and Dural Carotid Cavernous Sinus Fistulas: Comparison of Clinical Characteristics

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Likelihood of spontaneous closure of cavernous sinus dural arteriovenous fistulas based on clinical and radiological findings

“…The cause of visual acuity impairment in these patients with CSDAVF can be attributed to vascular congestion, likely leading to retina ischemia or venous stasis retinopathy. 6 These can be reversible if detected early and treated, as seen in our patients. Hence, early detection of deteriorating visual acuity with early intervention is important to prevent permanent and irreparable visual impairment.…”

Microvascular and neural alterations in carotid cavernous fistulas: An optical coherence tomography angiography study

“…The low-flow CCF patients (63% in our study and 83.3% in another study 8 ) had mild signs and symptoms, which could lead to delayed diagnosis and intervention,…”

“…The low‐flow CCF patients (63% in our study and 83.3% in another study 8 ) had mild signs and symptoms, which could lead to delayed diagnosis and intervention, resulting in vision loss. Therefore, a lower threshold of suspicion and a higher index of imaging diagnosis was required.…”

Direct and Dural Carotid Cavernous Sinus Fistulas: Comparison of Clinical Characteristics

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“……”

Likelihood of spontaneous closure of cavernous sinus dural arteriovenous fistulas based on clinical and radiological findings

“…The cause of visual acuity impairment in these patients with CSDAVF can be attributed to vascular congestion, likely leading to retina ischemia or venous stasis retinopathy. 6 These can be reversible if detected early and treated, as seen in our patients. Hence, early detection of deteriorating visual acuity with early intervention is important to prevent permanent and irreparable visual impairment.…”

Microvascular and neural alterations in carotid cavernous fistulas: An optical coherence tomography angiography study

“…The low-flow CCF patients (63% in our study and 83.3% in another study 8 ) had mild signs and symptoms, which could lead to delayed diagnosis and intervention,…”

“…The low‐flow CCF patients (63% in our study and 83.3% in another study 8 ) had mild signs and symptoms, which could lead to delayed diagnosis and intervention, resulting in vision loss. Therefore, a lower threshold of suspicion and a higher index of imaging diagnosis was required.…”

Direct and Dural Carotid Cavernous Sinus Fistulas: Comparison of Clinical Characteristics

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